Netarsudil no help in steroid-induced IOP elevation after corneal transplantation

Netarsudil falls short of reducing the risk of steroid-induced elevation of intraocular pressure (IOP) in patients who have received corneal transplant, a study has found.

The analysis included 120 patients assigned to off-label use of netarsudil or placebo once daily for 9 months after Descemet membrane endothelial keratoplasty, and fellow eyes assigned to receive placebo.

All participants concomitantly used topical prednisolone acetate 1% four times daily for 3 months, three times daily for a month, twice daily for a month, and once daily for 4 months. The primary efficacy endpoint of IOP elevation was defined as IOP ≥24 mm Hg or an increase of ≥10 mm Hg over baseline.

Overall, 95 eyes were treated with netarsudil and 96 with placebo. There were 15 eyes (16 percent) withdrawn prematurely from the netarsudil arm because of ocular irritation.

IOP elevation rate was lower with netarsudil than with placebo (14 percent vs 21 percent), although the difference was not clinically meaningful (relative risk, 0.6, 95 percent confidence interval [CI], 0.3–1.3; p=0.23).

Furthermore, a similar number of patients in the netarsudil and placebo groups had IOP of >30 mm Hg (7.8 percent vs in 7.4 percent, respectively; p=0.84).

Results were the same for median 6-month central endothelial cell loss, which was not significantly different between the two treatment groups (31 percent vs 29 percent, respectively; p=0.49).