Timolol versus brinzolamide added to travoprost in glaucoma or ocular hypertension

Background To compare the efficacy and safety of timolol 0.5% versus brinzolamide 1.0% when added to travoprost monotherapy in patients with primary open-angle glaucoma or ocular hypertension. Methods Patients meeting selection criteria (IOP one eye 19 mmHg and .32 mmHg and IOP both eyes .32 mmHg at 8:00 h) were switched to travoprost monotherapy for 4 weeks. Patients then insufficiently controlled on travoprost (IOP at 8:00 h .19 mmHg) at baseline were randomized to receive either travoprost and brinzolamide or travoprost and timolol in a double-masked fashion for 12 weeks. Results Two hundred and fifty-three patients underwent the 4-week run-in period. Switching to travoprost resulted in adequate IOP control (<19 mmHg) for 21.7% of patients. After 3 months of treatment, both drug combinations statistically significantly reduced the mean IOP at each time point (8:00, 12:00 and 16:00 h) and the mean diurnal IOP, which was 17.9}2.6 mmHg for the brinzolamide group and 17.0}3.2 mmHg for the timolol group. Both combinations were well-tolerated. However, a statistically significant difference occurred at 16:00 h, with pressures of 16.4}3.2 mmHg and 17.3} 2.8 mmHg for the timolol and brinzolamide groups, respectively (p=0.038). Fifty percent of patients reported one adverse event, whereas in 13.2% three or more adverse effects were named. Hyperemia was found most often (6.3% of the patients). Conclusion Both adjunctive combinations moderately reduced IOP in patients inadequately controlled with travoprost monotherapy, with timolol being slightly stronger 8 hours after instillation. Adjunctive treatment with brinzolamide and travoprost may be an alternative for patients not tolerant or not responsive to treatment with timolol and travoprost.