ABSTRACT

Background

Sustained release drug delivery has the potential to change glaucoma care by decreasing the challenge of medication adherence. Many approaches are in development, but this review focuses on Durysta (Allergan plc, Dublin, Ireland), the only FDA-approved sustained release intracameral treatment available at this time.

Key Findings

Durysta is a bimatoprost sustained release (BimSR) intracameral implant. Clinical trials have demonstrated that BimSR implants can provide comparable levels of intraocular pressure (IOP) control as topical eyedrops. BimSR has advantages such as decreasing concerns regarding drop adherence, reducing ocular surface and periocular side effects from topical drops, and decreased daily treatment burden for patients. In addition, studies have shown continued IOP lowering in some eyes during extended follow-up periods when all of the BimSR medication has already been delivered. Hypothesized mechanisms to explain this finding include increased matrix metalloproteinase expression that causes extracellular matrix reorganization to permit greater aqueous outflow, as well as decreased episcleral venous pressure. The major safety concern at this time for Durysta and future intracameral implants is corneal endothelial cell loss, which was worse with repeat BimSR administration compared to single dosing. Several studies are underway to investigate mechanisms of action and to better understand safe and effective dosing of medications in this class.

中文翻译：

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房内缓释比马前列素植入物（Durysta）

摘要

背景

缓释药物递送有可能通过减少药物依从性的挑战来改变青光眼护理。许多方法正在开发中，但本综述重点关注 Durysta（Allergan plc，都柏林，爱尔兰），这是目前唯一获得 FDA 批准的持续释放前房内治疗。

主要发现

Durysta 是一种比马前列素缓释 (BimSR) 前房内植入物。临床试验表明，BimSR 植入物可以提供与局部眼药水相当的眼内压 (IOP) 控制水平。BimSR 具有减少对滴剂粘附的担忧、减少局部滴剂的眼表和眼周副作用以及减轻患者日常治疗负担等优点。此外，研究表明，在所有 BimSR 药物已经交付的情况下，在延长的随访期内，一些眼睛的眼压持续降低。解释这一发现的假设机制包括增加的基质金属蛋白酶表达导致细胞外基质重组以允许更大的水流出，以及降低的巩膜外静脉压力。目前 Durysta 和未来的前房内植入物的主要安全问题是角膜内皮细胞丢失，与单次给药相比，重复 BimSR 给药更糟。正在进行几项研究以调查作用机制并更好地了解此类药物的安全有效剂量。