The dorzolamide/timolol combination versus timolol plus pilocarpine: Patient preference and impact on daily life

Purpose: To compare the 2.0% dorzolamide/0.5% timolol fixed combination (CO SOPT; Merck & Co., Whitehouse Station: NJ) to 0.5% timolol plus 2.0% piloca rpine given concomitantly, and to determine patient preference, tolerabilit y, and impact on daily life in patients with elevated intraocular pressure (IOP). Methods: Two multi-center, randomized, cross-over, observer masked studies were conducted, one in the United States (97 patients) and one in Europe (9 3 patients). The Comparison of Ophthalmic Medications for Tolerability ques tionnaire was used to assess patient preference and perception of side effe cts and activity limitations resulting from study medications. Intraocular pressure was measured before and 2 hours after the morning dose of study me dication (hour 0 and hour 2). Results: In both studies, among patients with a preference, the combination was preferred to timolol plus pilocarpine by a ratio of 4 to 1. The most c ommonly cited reason for this preference was side effects. Patients in both studies also reported that the combination interfered significantly less w ith daily life in terms of side effects and activity limitations. They also reported missing significantly fewer doses of study medication while takin g the combination and being significantly more satisfied with it. The effic acy of these two treatments was not significantly different, based on IOP m easurements at hour 0 and 2 hours after administration. Patients reported s ignificantly more adverse events while receiving timolol plus pilocarpine i n both studies, and in the U.S. study, significantly more patients disconti nued therapy while receiving timolol plus pilocarpine than while receiving the combination. Conclusion: Compared with timolol plus pilocarpine, patients preferred the combination of 2% dorzolamide/0.5% timolol, and reported less interference in daily activities, better tolerability, and better compliance with therap y.