Source: Medicines & Healthcare Products Regulatory Agency (GB) Revision Year: 2020 Publisher: LABORATOIRES THEA, 12 RUE LOUIS BLERIOT, 63017 CLERMONT-FERRAND CEDEX 2, France
Pharmacotherapeutic group: ANTIGLAUCOMA PREPARATIONS AND MIOTICS; Prostaglandin analogues
ATC code: S01EE01
The active substance latanoprost, a prostaglandin F2αanalogue, is a selective prostanoid FP receptor agonist which reduces the intraocular pressure by increasing the outflow of aqueous humour.
Studies in animals and man indicate that the main mechanism of action is increased uveoscleral outflow, although some increase in outflow facility (decrease in outflow resistance) has been reported in man.
Reduction of the intraocular pressure in man starts about three to four hours after administration and maximum effect is reached after eight to twelve hours. Pressure reduction is maintained for at least 24 hours.
Pivotal studies have demonstrated that latanoprost is effective as monotherapy. In addition, clinical trials investigating combination use have been performed. These include studies that show that latanoprost is effective in combination with beta-adrenergic antagonists (timolol). Short-term (1 or 2 weeks) studies suggest that the effect of latanoprost is additive in combination with adrenergic agonists (dipivalyl epinephrine), oral carbonic anhydrase inhibitors (acetazolamide) and at least partly additive with cholinergic agonists (pilocarpine).
Clinical trials have shown that latanoprost has no significant effect on the production of aqueous humour. Latanoprost has not been found to have any effect on the blood-aqueous barrier.
Latanoprost has no or negligible effects on the intraocular blood circulation when used at the clinical dose and studied in monkeys. However, mild to moderate conjunctival or episcleral hyperaemia may occur during topical treatment.
Chronic treatment with latanoprost in monkey eyes, which had undergone extracapsular lens extraction, did not affect the retinal blood vessels as determined by fluorescein angiography.
Latanoprost has not induced fluorescein leakage in the posterior segment of pseudophakic human eyes during short-term treatment.
Latanoprost in clinical doses has not been found to have any significant pharmacological effects on the cardiovascular or respiratory system.
MONOPOST was evaluated in a three-month, randomised, investigator-masked study comparing non-preserved MONOPOST with the preserved 0.005% latanoprost reference product in 404 ocular hypertensive or glaucomatous patients. The primary efficacy variable was the change in intraocular pressure between baseline and Day 84.
At Day 84, the intraocular pressure reduction induced by MONOPOST was -8.6 mmHg i.e -36%. It was similar to that of the preserved 0.005% latanoprost reference product.
| Worse eye (mITT population) | MONOPOST | Reference Product | |
|---|---|---|---|
| Baseline (D0) | n Mean ± SD | 189 24.1 ± 1.8 | 164 24.0 ± 1.7 |
| D84 | n Mean ± SD | 185 15.4 ± 2.3 | 162 15.0 ± 2.0 |
| Mean change (D0 – D84) | n Mean ± SD [95% CI] | 185 -8.6 ± 2.6 [-9.0 ; -8.3] | 162 -9.0 ± 2.4 [-9.4 ; -8.7] |
| Statistical analysis | E (SE) [95%CI] | 0.417 ± 0.215 [-0.006; 0.840] | |
This three-month trial showed the following undesirable effects for MONOPOST and the latanoprost reference product respectively: irritation/burning/stinging not upon instillation (at D84, 6.8% for MONOPOST and 12.9 % for latanoprost reference product) and conjunctival hyperaemia (at D84, 21.4% for MONOPOST and 29.1% for latanoprost reference product). Concerning systemic adverse events, no major difference is observed between the two treatment groups.
Latanoprost (mw 432.58) is an isopropyl ester prodrug which per se is inactive, but after hydrolysis to the acid of latanoprost becomes biologically active.
The prodrug is well absorbed through the cornea and all drug that enters the aqueous humour is hydrolysed during the passage through the cornea.
Studies in man indicate that the peak concentration in the aqueous humour is reached about two hours after topical administration. After topical application in monkeys, latanoprost is distributed primarily in the anterior segment, the conjunctivae and the eyelids. Only minute quantities of the drug reach the posterior segment.
In a three-month, cross-over randomised, pilot study in 30 hypertensive or glaucomatous patients, the latanoprost plasma level was measured and 30 minutes after instillation almost all patients had values which went down below the LOQ (40 pg/ml).
There is practically no metabolism of the acid of latanoprost in the eye. The main metabolism occurs in the liver. The half life in plasma is 17 minutes in man. The main metabolites, the 1,2-dinor and 1,2,3,4-tetranor metabolites, exert no or only weak biological activity in animal studies and are excreted primarily in the urine.
The ocular as well as systemic toxicity of latanoprost has been investigated in several animal species. Generally, latanoprost is well tolerated with a safety margin between clinical ocular dose and systemic toxicity of at least 1000 times. High doses of latanoprost, approximately 100 times the clinical dose/kg body weight, administered intravenously to unanaesthetised monkeys have been shown to increase the respiration rate probably reflecting bronchoconstriction of short duration. In animal studies, latanoprost has not been found to have sensitising properties.
In the eye, no toxic effects have been detected with doses of up to 100 micrograms/eye/day in rabbits or monkeys (clinical dose is approximately 1.5 micrograms/eye/day). In monkeys, however, latanoprost has been shown to induce increased pigmentation of the iris.
The mechanism of increased pigmentation seems to be stimulation of melanin production in melanocytes of the iris with no proliferative changes observed. The change in iris colour may be permanent.
In chronic ocular toxicity studies, administration of latanoprost 6 micrograms/eye/day has also been shown to induce increased palpebral fissure. This effect is reversible and occurs at doses above the clinical dose level. The effect has not been seen in humans.
Latanoprost was found negative in reverse mutation tests in bacteria, gene mutation in mouse lymphoma and mouse micronucleus test. Chromosome aberrations were observed in vitro with human lymphocytes. Similar effects were observed with prostaglandin F2α, a naturally occurring prostaglandin, and indicates that this is a class effect.
Additional mutagenicity studies on in vitro/in vivo unscheduled DNA synthesis in rats were negative and indicate that latanoprost does not have mutagenic potency. Carcinogenicity studies in mice and rats were negative.
Latanoprost has not been found to have any effect on male or female fertility in animal studies. In the embryotoxicity study in rats, no embryotoxicity was observed at intravenous doses (5, 50 and 250 micrograms/kg/day) of latanoprost. However, latanoprost induced embryolethal effects in rabbits at doses of 5 micrograms/kg/day and above.
The dose of 5 micrograms/kg/day (approximately 100 times the clinical dose) caused significant embryofoetal toxicity characterised by increased incidence of late resorption and abortion and by reduced foetal weight.
No teratogenic potential has been detected.
Ocular administration of MONOPOST eye drops to animals twice a day during 28 days did not demonstrate any local or systemic toxic effect.
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