Abstract

Purpose: Netarsudil, a Rho-associated protein kinase inhibitor combined with a norepinephrine transporter inhibitor, is a novel anti-glaucoma medication. Approval trials have demonstrated a reduction in the intraocular pressure (IOP), but phase IV data has been sparse. This study was designed to provide real-world efficacy and safety data for netarsudil in clinical use.

Methods: A single center retrospective review at a University Hospital outpatient clinic was performed to assess the pressure-lowering effect of netarsudil 0.02% on patients with glaucoma. We included all patients who were treated with netarsudil at our institution. Exclusion criteria included less than one month of follow-up. The indication for adding netarsudil 0.02% at bedtime was determined on a case-by-case basis by the treating glaucoma specialist. The main outcome measure was the change in intraocular pressure (IOP) following the addition of netarsudil. The secondary outcome measure was the rate of adverse events throughout the 6-month treatment period.

Results: A total of 147 patients were started on netarsudil. The average age was 72 +/- 12 years old. The mean baseline IOP was 20.1 +/- 6.5 mmHg. After 6 months, the mean IOP had decreased 5 mmHg to 15.1 +/- 5.1 mmHg, a 25% reduction, while 44% achieved an IOP < 14 mmHg. The mean number of medications was similar at 3.8 +/- 1 medications at baseline and 3.6 +/- 1 at 6 months. Adverse events occurred in 60 patients (41%). The most common adverse event was conjunctival hyperemia which occurred in 19%, followed by dryness in 19%.

Conclusion: Adding netarsudil to a group of patients on previously core topical therapy still reduced the IOP at 6 months by a mean of 25%. Netarsudil was effective as an additive treatment to patients on multiple medications.

Keywords: Netarsudil; Rho Kinase Inhibitor; Norepinephrine Transporter Inhibitor; Glaucoma

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