Articole stiintifice – Combinatii fixe medicamentoase topice in tratamentul glaucomului

Combinatiile fixe reprezinta o combinare a doua medicatii hipotensive oculare intr-o singura solutie. Combinatiile fixe medicamentoase topice utilizate astazi in tratamentul glaucomului sunt Combiganul, Cosoptul, Xalcomul, Duotravul si Ganfortul.

Superioritatea statistic semnificativa a eficientei hipotensoare oculare a combinatiilor fixe fata de monoterapia cu cele doua componente individuale este prezenta pentru Cosopt si Xalcom.

Este deasemenea prezenta fata de timolol la Combigan,Duotrav si Granfort dar lipseste la aceste combinatii fixe fata de brimonidina, travatan si respectiv bimatoprost.

O reducere usoara insignifianta clinic si statistic in eficienta combinatiilor fixe fata de cele nonfixe (administrarea concomitenta dar separata a celor doua componente) este acceptabila daca aceasta este balansata de beneficiile potentiale ale terapiei cu combinatiile fixe (tolerabilitate imbunatatita, convenienta crescuta, complianta marita, economie de cost si timp, eliminare a efectului wash-out si expunere redusa la solutia utilizata ca prezervativ).

Cuvinte cheie:

  • combinatii fixe
  • monoterapie
  • combinatii nonfixe

Tratamentul glaucomului incepe, conform Ghidului European de Glaucom [1s, prin folosirea unuia din medicamentele apartinand celor 4 grupe de hipotensoare oculare cunoscute (betablocante, agonisti alfa adrenergici, inhibitori ai anhidrazei carbonice si prostaglandine).

40% din Caucazieni (si 45% din afro-americani) necesita mai mult decat o singura medicatie pentru a atinge scaderea modesta a tensiunii oculare (TO) de 20% din valoarea bazala [2s.

Cand reducerea tintita a TO nu poate fi atinsa cu monoterapia initiala, se poate recurge la o alta monoterapie dar deobicei se face abgradarea la combinatii medicamentoase.

Aceasta pot imbraca forma combinatiilor fixe (CFs) (combinarea a doua medicatii hipotensoare oculare intr-o singura sticluta) sau pe cea a combinatiilor nonfixe (CNFs)(administrarea concomitenta dar separata a celor doua medicatii).

Sursa:  Societatea Romana de Glaucom >>


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