Glaucoma Drug Combo Dosed Once Daily Superior to Twice Daily

Doctor apply artificial tears gel to senior woman patient eye for treatment dry eye
Doctor apply artificial tears gel to senior woman patient eye for treatment dry eye
The once-a-day regimen of bimatoprost-brimonidine tartrate-timolol maleate better reduces peak intraocular pressure, according to a study.

A once-daily fixed combination of bimatoprost, brimonidine tartrate, and timolol maleate reduces peak intraocular pressure (IOP) more effectively than a twice-a-day dosing regimen, according to results of a randomized clinical trial, published in the Journal of Glaucoma.

This study recruited patients (N=30) with primary open-angle glaucoma (POAG) between 2020 and 2021 at the ABC Foundation School of Medicine in Brazil. Patients with bilateral disease were instructed to instill bimatoprost 0.01%, brimonidine tartrate 0.15%, and timolol maleate 0.5% at 10:00 am and 10:00 pm in 1 eye and at 10:00 pm in the other eye for 90 days. The eye assignment for receiving the twice-a-day or once-a-day regimen was randomized. IOP pressure peaks were evaluated using a basal water drinking test at baseline and one, two, and three months.

Patients were 50% men, aged mean 70.4±8.2 years, 57% were Black, 53% had received 3 or more topical hypotensive therapy treatments, and 67% were receiving prostaglandin analog treatment.

At baseline no significant differences were observed for central corneal thickness, mean deviation, visual acuity, glaucoma stage, use of 3 or more drugs, previous prostaglandin or prostamide analog therapy, peak IOP, or IOP among eyes randomized to receive once or twice daily therapy.

At month 3, the reduction from baseline in peak IOP was greater for the once-a-day therapy (mean, 30.50% vs 21.50%; P =.023; mean, 6.1 vs 4.3 mmHg; P =.023) as was the peak reduction at all visits (mean, 5.90 vs 4.46 mmHg; P =.006).

The majority of eyes in both groups (n=24 vs n=24) achieved an IOP lower than 18 mm Hg. More eyes that received a once daily treatment regimen achieved IOP lower than 10 mm Hg (n=6 vs n=1).

The major limitation of this study was the possibility that patients could have administered the wrong regimen to an eye on some days.

This study found that administering the drugcombination once per day was more effective at reducing peak IOP in POAG eyes.


Susanna BN, Susanna CN, Susanna FN, et al. Intraocular peak pressure in patients under treatment with Fixed combination of Bimatoprost/ Timolol/ Brimonidine once daily versus twice daily.J Glaucoma. Published online May 6, 2022. doi:10.1097/IJG.0000000000002048