The introduction of Rocklatan, a once-daily, fixed-dose combination of the rho kinase inhibitor netarsudil and the prostaglandin analogue latanoprost, has broadened the spectrum of medical management for patients with open-angle glaucoma or ocular hypertension.
Three-month data from the randomized, double-masked MERCURY 1 trial[1] provided compelling evidence to support its recent approval by the US Food and Drug Administration. This trial compared the safety and efficacy of this fixed-dose combination versus monotherapy with netarsudil or latanoprost alone in adult patients with either primary open-angle glaucoma or ocular hypertension. Patients were eligible for inclusion if the intraocular pressure (IOP) in both unmedicated eyes was > 20 mm Hg but < 36 mm Hg at 8 AM, and > 17 mm Hg but < 36 mm Hg at 10 AM and 4 PM. Those who were on ocular hypotensive medications had to undergo an appropriate washout period. Patients were excluded if they were on more than two ocular hypotensive medications. The primary endpoint was mean IOP at 8 AM, 10 AM, and 4 PM at week 2, week 6, and month 3.
The trial found that the fixed-dose combination drop reduced IOP 1.3-3.0 mm Hg more than either netarsudil or latanoprost alone. A statistically significantly higher proportion of patients achieved diurnal IOP < 15 mm Hg with the combination than with monotherapy. Overall, the combination met superiority criteria at all time points.
