ROCK-solid Inhibition in Glaucoma Therapy

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Question 1
What is the primary mechanism by which netarsudil lowers intraocular pressure?
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The correct answer is B.

Rationale: Netarsudil works by the following mechanisms:

Rho Kinase Inhibitor

1. Increases trabecular outflow

  • Relax TM smooth muscle actin and myosin
  • Induce cell rounding and cell-cell detachment
  • Widen extracellular spaces in TM and juxtacanalicular tissue

2. Decreases episcleral venous pressure

  • Dilates episcleral veins

NET Inhibitor

3. Decreases aqueous production

  • Blocks reuptake of norepinephrine, enhances endogenous norepinephrine signaling

Kazemi, A et al. J Ocul Pharmacol Ther. 2018;34(5):380-6.
Kopczynski CC, et al. J Ocul Pharmacol Ther. 2014;30(2-3):85-7.
Wang RF, et al. J Glaucoma. 2015;24(1):51-4.

Question 2
Which of the following is true regarding the efficacy and safety of netarsudil?
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The correct answer is C.

Rationale: IOP-lowering effect of netarsudil 0.02% is independent of baseline IOP.

Question 3
Significantly more patients treated with netarsudil 0.02% had a ≥20% reduction in IOP than patients treated with timolol in the groups of patients with baseline IOPs of:
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The correct answer is A.

Rationale: Significantly more patients treated with netarsudil ophthalmic solution 0.02% had a ≥20% reduction in IOP than patients treated with timolol in the groups of patients with baseline IOPs <22 mmHg or <23 mmHg.

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