Effects of Cosopt on IOP and on Ocular Diastolic Perfusion Pressure

NCT ID: NCT00796198

Last Updated: 2008-11-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-12-31

Study Completion Date

2009-07-31

Brief Summary

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Hypothesis: Studies suggest that patients with low diastolic velocity and high resistivity index in the ophthalmic artery had more progressive visual fields, the investigators hypothesize therefore that addition of Cosopt to Latanoprost could improve ocular diastolic perfusion pressure (ODPP).

Objective: To evaluate the effects of Cosopt on ODPP in patients not adequately controlled with latanoprost alone.

Detailed Description

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Fifty patients with primary open angle glaucoma (POAG) treated with Xalatan for whom the monotherapy was not sufficient to achieve the target IOP, will be included in the study. Non responders were defined when IOP was \> 20 mmHg or if the IOP reduction was less than 25% from the baseline IOP. Patients will be classified as having POAG when they had a typical glaucomatous visual field and/or a typical abnormal optic nerve head, open angle at gonioscopy, IOP \> 21 mmHg with no treatment and no clinically apparent secondary cause for their glaucoma (EGS guidelines).

Visual fields will be assessed by an Humphrey Field Analyzer 750 (HFA, Humphrey, Inc, CA, USA), 24-2 SITA (Swedish Interactive Threshold Algorithm) standard. A glaucomatous visual field defect was defined as: 1) three adjacent points depressed by 5 dB, with one of the points depressed by at least 10 dB; 2) two adjacent points depressed by 10 dB; or 3) a 10 dB difference across the nasal horizontal meridian in two adjacent points. None of the points could be edge points unless immediately above or below the nasal horizontal meridian. In addition, visual field testing was considered reliable only when false-negative responses were less than 30% and fixation losses were less than 20% on HFA.

The abnormal optic nerve head classification was based on the presence of an optic rim notch or of diffuse / generalized loss of optic rim tissue, vertical cup/disc diameter ratio asymmetry unexplained by side differences in optic disc size, disc haemorrhage.

In each centre, patient's recruitment will start as soon as the ethical committee will approve the protocol. Each sites will recruit 10 patients (5 + 5).

Cosopt will be added to Xalatan when Xalatan is effective but not sufficient to reach the target pressure (Add group) (n = 25), while when Xalatan is effective and sufficient to reach the target pressure no other medication will be added (control group) (n = 25).

(EGS guidelines: Target pressure is a subjective value that none is able to assess (until now!). Efficacy of a drug: when the medication can decrease IOP as described in the phase three of their clinical trial. Not sufficient: when the medication is effective but is not able to reach the target IOP.)

Each patient will be submitted to three different visits:

* Baseline visit: Systemic Pressure, IOP, VF, HRF, Visual Acuity, ophthalmic examination with corneal central thickness (CCT)
* Visit at 1 month: Systemic Pressure , IOP, Visual Acuity, ophthalmic examination
* Visit at 3 months: Systemic Pressure, IOP , HRF, Visual Acuity, ophthalmic examination (+ CCT) ODPP will be calculated by: "systemic diastolic pressure - IOP" at each session.

Conditions

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Glaucoma

Keywords

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Glaucoma Intraocular pressure Ocular diastolic perfusion pressure Dorzolamide/timolol Fixed combination Heidelberg Retina Flowmeter

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Xalatan+Cosopt

Cosopt will be added to Xalatan when Xalatan is effective but not sufficient to reach the target pressure (Add group) (n = 25)

Group Type ACTIVE_COMPARATOR

Xalatan+Cosopt

Intervention Type DRUG

Xalatan ophthalmic solution one drop at 10pm + Cosopt ophthalmic solution one drop at 8am and one drop at 8 pm

Xalatan

Intervention Type DRUG

Xalatan ophthalmic solution one drop at 10pm

Xalatan

when Xalatan is effective and sufficient to reach the target pressure no other medication will be added (control group) (n = 25)

Group Type ACTIVE_COMPARATOR

Xalatan

Intervention Type DRUG

Xalatan ophthalmic solution one drop at 10pm

Interventions

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Xalatan+Cosopt

Xalatan ophthalmic solution one drop at 10pm + Cosopt ophthalmic solution one drop at 8am and one drop at 8 pm

Intervention Type DRUG

Xalatan

Xalatan ophthalmic solution one drop at 10pm

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* POAG patients with a pattern deviation score (or its equivalent) ranging from 2.5 dB to 6.0 dB will be included in the study. This will ensure that patients with early/mid-stage glaucoma will be homogeneously collected; avoids advanced glaucoma in which OBF may behave as a different disease state.
* Best-corrected visual acuity will be of 0.5 or better with an ametropia \<5D - Dioptric transparency, non smokers.
* Age will be between 45 and 65 years.

Exclusion Criteria

* Normal tension glaucoma, ocular hypertension, cardiovascular and/or metabolic diseases (known to affect blood flow, as diabetes and polycythemia)
* Visual field defects other than glaucoma; use of vasoactive and/or anti-hypertensive drugs (systemic beta-blocker), use of acetazolamide
* Hypersensibility and/or contraindications to any of the molecules studied
* Previous ocular surgery
* Pregnant or nursing women and use of one of drugs for erectile dysfunction
Minimum Eligible Age

45 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Turin, Italy

OTHER

Sponsor Role lead

Responsible Party

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University of Turin, Department of di Physiopathology Clinic-Section of Ophthalmology-Eye Clinic

Principal Investigators

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Teresa Rolle, MD, Assistent Professor

Role: PRINCIPAL_INVESTIGATOR

University of Turin, Department of Clinical Physiopathology, Section of Ophthalmology, Eye Clinic

Teresa Rolle, MD, Assistent Professor

Role: PRINCIPAL_INVESTIGATOR

University of Turin, Department of Clinical Physiopathology-Section of Ophthalmology-Eye Clinic

Locations

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University of Bari

Bari, , Italy

Site Status

University of Chieti

Chieti, , Italy

Site Status

University of Genova

Genova, , Italy

Site Status

University of Siena

Siena, , Italy

Site Status

University of Turin

Turin, , Italy

Site Status

Countries

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Italy

Central Contacts

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Teresa Rolle, MD

Role: CONTACT

Phone: 00390115666032

Email: [email protected]

Facility Contacts

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Michele Vetrugno, MD

Role: primary

Marco Ciancaglini, MD

Role: primary

Michele Iester, MD

Role: primary

Paolo Frezzotti, MD

Role: primary

Teresa Rolle, MD

Role: primary

Other Identifiers

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COS16102007

Identifier Type: -

Identifier Source: org_study_id