Late-Onset Ocular Hypotensive Effect of Ripasudil on Primary Open-Angle Glaucoma

Kei Sano,1 Ryo Terauchi,1 Kota Fukai,2 Shumpei Ogawa,1 Takahiko Noro,1 Masayuki Tatemichi,2 Tadashi Nakano1 1Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, 105-8461, Japan; 2Department of Preventive Medicine, Tokai University School of Medicine, Isehara, 259-1193, JapanCorrespondence: Ryo Terauchi, Department of Ophthalmology, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Tokyo, Minato-ku, 105-8461, Japan, Tel +81 3-3433-1111, Fax +81 3-3433-1936, Email [email protected]: We evaluated the late-onset ocular hypotensive effect of ripasudil after long-term administration in real-world clinical data and investigated its associated factors in primary open-angle glaucoma (POAG).Patients and Methods: We reviewed the clinical patients with POAG who newly started ripasudil without changes of treatment. Enrolled eyes were assigned to two groups: positive group with the late-onset effect and negative group. Eyes that show the late-onset effect 6 months after starting ripasudil were defined as positive. Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the late-onset effect.Results: We enrolled 74 eyes of 74 patients with POAG (age, 67.5 ± 10.9 years; mean deviation, − 11.2 ± 5.9 dB) and followed them for 14.2 ± 5.0 months. Among them, 12 (16.2%) eyes were assigned to the positive group. Retinal nerve fiber layer (RNFL) thickness (73.4 ± 12.9 vs 64.0 ± 9.8 μm, P = 0.04) and primary IOP (18.8 ± 4.1 vs 15.8 ± 4.3 mmHg, P = 0.01) before starting ripasudil were higher in the positive group than in the negative group. The late-onset effect was associated with higher IOP (OR, 1.22; 1.01– 1.48) and thicker RNFL (2.76; 1.15– 6.63).Conclusion: Some patients with POAG showed the late-onset IOP-lowering effect of ripasudil, and its associated factors were higher IOP and thicker RNFL. The addition of ripasudil may offer potential benefits particularly for early-stage glaucoma with thicker RNFL.Keywords: ripasudil, ROCK-inhibitor, glaucoma, ocular hypertension, intraocular pressure