AGS 2024: Travoprost intraocular implant in OAG and OHT subjects

I. Paul Singh, MD, sat down with David Hutton of Ophthalmology Times to discuss his poster "Travoprost Intraocular Implant Demonstrates Efficacy in Diverse Subpopulations of OAG and OHT Subjects," from the American Glaucoma Society meeting held in Huntington Beach

Video Transcript

Editor's note - This transcript has been edited for clarity.

David Hutton:

I'm David Hutton of Ophthalmology Times. The American Glaucoma Society is holding its annual meeting in Huntington Beach, California. At the meeting, Dr. Inder Paul Singh presented a poster titled Travoprost Intraocular Implant Demonstrates Efficacy in Diverse Subpopulations of OAG and OHT Subjects. Thank you so much for joining us today. Tell us about this topic.

Inder Paul Singh, MD:

Thank you so much for having me. I appreciate the opportunity. It's an honor to be here. And, yeah, it's an exciting topic. Drug delivery is something that we've had now for a few years in the form of processing sustained release, which is a biodegradable implant. And now we have this approval of this non-biodegradable intracameral implant of travaprost that releases an oil that releases for many, many months and years, even in terms of some of the datasets that we have.

And the Phase III trials that were done to get this approved is called iDose. They were two large multicenter, randomized controlled trials. And what we did is we looked at the data and did a subgroup analysis, kind of retrospective. We looked at those data sets and said, okay, can we see is there a difference in efficacy between different subgroups of glaucoma? And so we've said, Okay, let's look at age, let's look at patients who are above 65 versus lower than 65, or less than 65, and say, is there a change in efficacy or outcomes there? What about sex - male versus female? Race, ethnicity, so African Americans versus Hispanics versus Caucasians. Disease severity - people that say earlier mild will say ocular hypertensives versus those who are more moderate, let's say. Is there a difference in how well it works there, or even mean baseline IOP, those who had higher IOPs to begin with, versus those who had lower IOP, let's say less than 25 or greater than 25.

And also, number of medications, those who are less than 0 meds going into it, versus those who are on 1 or 2 or 3 meds. In real life in glaucoma, we don't see the same patient, the same type of patient, we see a variety of type of phenotypes of glaucoma. We want to see would this change the different types of subgroups in terms of efficacy. And again, this was a study that was looking at a comparator of timolol. And it was a non-inferiority study 6 weeks and after 3 months was the actual main outcome analysis.

So we're looking at whether there was there any difference in noninferiority between travoprost oil, which is a nonbiodegradable implant, versus timolol? And so we look at the data. The bottom line is whether you look at race, age, sex, number meds, severity of disease - we did not see a difference in efficacy. And we found the same efficacy in all of those subgroup analyses as well. So, it made me feel comfortable as a glaucoma specialist to see so many different types of glaucoma, from mild to moderate to severe, and African Americans, Caucasians, different IOP baselines that we do know that this does work in those different subpopulations of patients.

David Hutton:

Ultimately, what can this mean for patients?

Inder Paul Singh, MD:

Well, I think what it means is that we have an alternative. We have now two different modalities to deliver medications. One is a biodegradable implant, one now with a nonbiodegradable implant that will hopefully work in a large number of patients. As a doctor, as a patient now, we do not have to make our patients suffer by taking medication. Now, we do have SLT firstline for a lot of our patients, but we have now drug delivery. So if someone let's say needs something more than SLT, or is on a drop and having an issue of compliance with the cost, side effects, forgetfulness, hyperemia, whatever it might be, we know that compliance is a real barrier to long-term stability of glaucoma.

Now, we have these opportunities to involve or to utilize this technology in a number of different type of patients. And as a surgeon, we're not having to worry about okay, well, you're only this type of subtype, it won't work for you, but it worked for this person. We are more open and we don't have to think about which patient it will work on. As long as they have an open angle, and they tolerate a PGA. This could be an alternative to being on topical medications for a period of time.

David Hutton:

And lastly, what are the next steps for this study?

Inder Paul Singh, MD:

I think the next steps for drug delivery in general is, can we start to look at even longer duration of effect. Glaukos is working on even longer duration. Their Phase II trials showed us when he had the Exchange study at 2 years, there's still over 15% or 17% of drug left in that reservoir even at 2 years. So we do think we're getting 3 years, even longer potential efficacy. Having 24-hour delivery of medication to the site of the target tissue, I think is really important because we're seeing longevity, even beyond the release of the medication. So even when the medication runs out, and even the latanaprost or even with this travoprost, we're seeing patients still maintain efficacy and control longer than even the drug is there. So, are we changing the disease processes? Are we modulating the actual pathology of the disease?

This is exciting. I think more research needs to be done on that level. And then also visual field ... long-term visual field analyses. Are we seeing better control like we do with the SLT studies and MIGS studies? Are we seeing better control of visual field function long term. And lastly, different molecules. Can we utilize, let's say Rho kinase inhibitors and other molecules in these drug delivery platforms and even different parts of the eye ... the vitreous, even in the, let's say the subarachnoid space. So I think drug delivery is just at its infancy. We are at the tip of the iceberg of what we can do for patients and helping them control their disease long term