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Nishani Amerasinghe discusses the practical benefits of Roclanda – Santen’s latest glaucoma treatment
The most common form of glaucoma in the UK, primary open angle glaucoma (POAG), affects approximately two percent of people aged 40 and over, rising to nearly 10 percent in those over 75 years old. To better treat this incurable disease, Santen has launched Roclanda across the UK. Roclanda is a fixed-dose combination of latanoprost and netarsudil that simultaneously lowers intraocular pressure (IOP) and targets trabecular meshwork (TM) dysfunction. To understand how this new medication could benefit glaucoma patients, The New Optometrist spoke with Nishani Amerasinghe, a consultant ophthalmic surgeon at the University Hospital Southampton specializing in glaucoma and cataract surgery.
What distinguishes Roclanda from other existing glaucoma medications?
The beauty of Roclanda is that it’s basically acting on a pathway that none of the other drugs are targeting – the trabecular meshwork and its critical role in maintaining intraocular pressure (IOP). Indeed, because Roclanda contains both latanoprost and netarsudil, it actually targets two pathways for lowering IOP – the uveoscleral and trabecular meshwork pathways. Working on the trabecular meshwork, the drug allows for more outflow of aqueous humour (AH), lowering the pressure that way – that’s the Rho-kinase (ROCK) inhibitor pathway, which is the netarsudil side of it. The latanoprost acts on the uveoscleral pathway and allows for AH and IOP reduction. So you’ve got two ways of lowering the pressure. This is a major shift – we haven’t had anything like it for 25 years. It’s a completely new drug for glaucoma and intraocular pressure control.
What will this launch mean for glaucoma patients in the UK?
We had four main agents to drop pressures – now we have another one. The other beauty of Roclanda is that it doesn’t contain a beta blocker, so it won’t have the systemic side effects that beta blockers have. Because the glaucoma population is generally elderly – with comorbidities, respiratory problems, and cardiac problems – the use of beta blockers, a second-line drug, is limited with this population. Instead, Roclanda would be used as a second-line drug, and without those associated side effects, this will be a game changer for us.
Santen says that Roclanda signifies “a new direction for the management of glaucoma.” Where do you think it will eventually lead?
A new second-line drug that is taken as one drug – essentially with both drops in one formulation – will improve patient compliance. Every time patients have to take more drops in combination, their compliance goes down. We won’t have that problem with Roclanda. I think this is exciting for physicians, because we haven’t had anything new, from an agent point of view for over 20 years, which is longer than I’ve been practicing ophthalmology.
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