Latanoprost–netarsudil is recommended as an option for reducing intraocular pressure (IOP) in adults with primary open-angle glaucoma or ocular hypertension when a prostaglandin analogue alone has not reduced IOP enough, only if:
they have then tried a fixed-dose combination treatment and it has not reduced IOP enough, or
a fixed-dose combination treatment containing beta-blockers is unsuitable.
This recommendation is not intended to affect treatment with latanoprost–netarsudil that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS healthcare professional consider it appropriate to stop.
Why the committee made these recommendations
Usual treatment for reducing IOP in people with primary open-angle glaucoma or ocular hypertension includes a prostaglandin analogue eye drop (for example, bimatoprost or latanoprost). If this does not work well enough, people usually have a fixed-dose combination treatment eye drop. These include combinations of a prostaglandin analogue with a beta-blocker (for example, bimatoprost–timolol), or a prostaglandin analogue with carbonic anhydrase inhibitors or sympathomimetics.
Latanoprost–netarsudil is a fixed-dose combination treatment containing a prostaglandin analogue with a Rho kinase inhibitor. For this evaluation, the company asked for latanoprost–netarsudil to be considered only after a fixed-dose combination treatment has not worked well enough or when a fixed-dose combination treatment with a beta-blocker is unsuitable.
Clinical trial evidence suggests that latanoprost–netarsudil is as effective as bimatoprost–timolol. Indirect comparisons of latanoprost–netarsudil with other fixed-dose combination treatments are highly uncertain, but suggest that they have similar effectiveness.
A cost comparison suggests that latanoprost–netarsudil has similar or lower costs than most branded fixed-dose combination treatments. These are usually used after a fixed-dose combination treatment has not reduced IOP enough. Latanoprost–netarsudil also has similar or lower costs compared with some generic fixed-dose combination treatments. So, latanoprost–netarsudil is recommended.