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Initial intraocular pressure reduction by mono- versus multi-therapy in patients with open-angle glaucoma : results from the Glaucoma Intensive Treatment Study

Lindén, Christina; Heijl, Anders LU ; Jóhannesson, Gauti; Aspberg, Johan LU ; Andersson Geimer, Sabina LU and Bengtsson, Boel LU (2018) In Acta Ophthalmologica 96((6)). p.567-572
Abstract

PURPOSE: To study newly diagnosed glaucoma patients given mono- or multi-therapy regarding differences in initial intraocular pressure (IOP) reduction, target IOP levels reached and influence of untreated baseline IOP on IOP reduction.

METHODS: Patients newly diagnosed with manifest primary open-angle glaucoma and included in the Glaucoma Intensive Treatment Study (GITS) were randomized to immediate intensive treatment with any of three different IOP-lowering substances supplied in two bottles plus 360° laser trabeculoplasty or to conventional stepwise treatment starting with a single-drug. Intraocular pressure reduction was analysed 1 month after initiation of treatment.

RESULTS: One hundred eighteen patients (143 eyes)... (More)

PURPOSE: To study newly diagnosed glaucoma patients given mono- or multi-therapy regarding differences in initial intraocular pressure (IOP) reduction, target IOP levels reached and influence of untreated baseline IOP on IOP reduction.

METHODS: Patients newly diagnosed with manifest primary open-angle glaucoma and included in the Glaucoma Intensive Treatment Study (GITS) were randomized to immediate intensive treatment with any of three different IOP-lowering substances supplied in two bottles plus 360° laser trabeculoplasty or to conventional stepwise treatment starting with a single-drug. Intraocular pressure reduction was analysed 1 month after initiation of treatment.

RESULTS: One hundred eighteen patients (143 eyes) received mono-therapy and 122 patients (152 eyes) multi-therapy. Median baseline IOP was 24.0 (min: 9.7, max: 56.0) mmHg in mono-therapy eyes and 24.0 (min: 12.3, max: 48.5) mmHg in multi-therapy eyes (p = 0.56). After 1 month in the two groups, respectively, values for median IOP reduction were 6.3 (range: -5.3-31.0) and 11.0 (range: 0.7-34.5) mmHg, and for mean relative decline 26.8 (range: -32.0-55.4) and 46.0 (range: 4.6-81.6) % (p = 0.000). A larger proportion of the multi-therapy patients reached each target IOP level (p = 0.000). The higher the baseline IOP, the larger the observed pressure reduction, considering both absolute and relative figures. The effect was more pronounced in eyes with multi-therapy than in those with mono-therapy (p = 0.000). For every mmHg higher IOP at baseline, the IOP was reduced by an additional 0.56 (mono-therapy) or 0.84 (multi-therapy) mmHg.

CONCLUSION: Intensive treatment led to considerably greater IOP reduction than mono-therapy. Among patients with IOP ≥30 mmHg at diagnosis an IOP of <16 was reached in 2/3 of those with multi-therapy but in none with mono-therapy. The IOP reduction was highly dependent on the untreated IOP level.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Ophthalmologica
volume
96
issue
(6)
pages
567 - 572
publisher
Wiley-Blackwell
external identifiers
  • scopus:85053663670
ISSN
1755-3768
DOI
10.1111/aos.13790
language
English
LU publication?
yes
id
5c3f9c68-af66-41f9-88e8-fded5d903b49
date added to LUP
2018-09-23 14:04:00
date last changed
2019-01-06 14:05:23
@article{5c3f9c68-af66-41f9-88e8-fded5d903b49,
  abstract     = {<p>PURPOSE: To study newly diagnosed glaucoma patients given mono- or multi-therapy regarding differences in initial intraocular pressure (IOP) reduction, target IOP levels reached and influence of untreated baseline IOP on IOP reduction.</p><p>METHODS: Patients newly diagnosed with manifest primary open-angle glaucoma and included in the Glaucoma Intensive Treatment Study (GITS) were randomized to immediate intensive treatment with any of three different IOP-lowering substances supplied in two bottles plus 360° laser trabeculoplasty or to conventional stepwise treatment starting with a single-drug. Intraocular pressure reduction was analysed 1 month after initiation of treatment.</p><p>RESULTS: One hundred eighteen patients (143 eyes) received mono-therapy and 122 patients (152 eyes) multi-therapy. Median baseline IOP was 24.0 (min: 9.7, max: 56.0) mmHg in mono-therapy eyes and 24.0 (min: 12.3, max: 48.5) mmHg in multi-therapy eyes (p = 0.56). After 1 month in the two groups, respectively, values for median IOP reduction were 6.3 (range: -5.3-31.0) and 11.0 (range: 0.7-34.5) mmHg, and for mean relative decline 26.8 (range: -32.0-55.4) and 46.0 (range: 4.6-81.6) % (p = 0.000). A larger proportion of the multi-therapy patients reached each target IOP level (p = 0.000). The higher the baseline IOP, the larger the observed pressure reduction, considering both absolute and relative figures. The effect was more pronounced in eyes with multi-therapy than in those with mono-therapy (p = 0.000). For every mmHg higher IOP at baseline, the IOP was reduced by an additional 0.56 (mono-therapy) or 0.84 (multi-therapy) mmHg.</p><p>CONCLUSION: Intensive treatment led to considerably greater IOP reduction than mono-therapy. Among patients with IOP ≥30 mmHg at diagnosis an IOP of &lt;16 was reached in 2/3 of those with multi-therapy but in none with mono-therapy. The IOP reduction was highly dependent on the untreated IOP level.</p>},
  author       = {Lindén, Christina and Heijl, Anders and Jóhannesson, Gauti and Aspberg, Johan and Andersson Geimer, Sabina and Bengtsson, Boel},
  issn         = {1755-3768},
  language     = {eng},
  month        = {09},
  number       = {(6)},
  pages        = {567--572},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Ophthalmologica},
  title        = {Initial intraocular pressure reduction by mono- versus multi-therapy in patients with open-angle glaucoma : results from the Glaucoma Intensive Treatment Study},
  url          = {http://dx.doi.org/10.1111/aos.13790},
  volume       = {96},
  year         = {2018},
}