What Is Vesneo?

Vesneo Glaucoma MedicationVesneo (latanoprostene bunod) is an experimental glaucoma medication developed by French pharmaceutical firm Nicox. Described as a “nitric oxide-donating prostaglandin F2-alpha analog” it is essentially a prostaglandin analog “plus”. Prostaglanding analogs such as Xalatan® (latanoprost), Lumigan® (bimatoprost), Travatan-Z® (travoprost), and Zioptan™ (tafluprost) work by opening the uveoscleral pathway through which aqueous fluid can leave the eye.

Nitric oxide is a free-radical that can induce oxidative damage and result in death of the retinal ganglion cells. Why, then, would a drug company want to create a glaucoma medication that “donates” nitric oxide? Wouldn’t it make sense to instead create a nitric oxide “stealing” or “scavenging” molecule?

As with most things in physiology, nitric oxide is neither “good” nor “bad” for the optic nerve. Rather, like red wine, its function depends upon when, where, and how much of it is available. Indeed, it was even named “Molecule of the Year” in 1992[1] and a Nobel Prize was awarded in 1998 for research about nitric oxide.

Nitric oxide is used by cells to “signal” or communicate with each other.[2] Additionally, it has a powerful dilating effect on blood vessels. Inadequate blood supply to the optic nerve may play a role in glaucoma. Thus, it makes sense that molecules with the ability to modify blood supply could have a beneficial effect in the treatment of glaucoma.

Initial Glaucoma Study Results of Vesneo (latanoprostene bunod)

According to a recent press release of Nicox’s “Phase 3” study, Vesneo (latanoprostene bunod) used once daily (QD) was compared against timolol maleate 0.5% used twice daily. Over eight hundred patients were enrolled in this study. Vesneo (latanoprostene bunod) was demonstrated to be “non-inferior” to timolol. That essentially means that it worked at least as well as timolol.

In study participants using Vesneo (latanoprostene bunod) a reduction in average intraocular pressure (IOP) of 7.5 to 9.1 mmHg from baseline was noted between 2 and 12 weeks of treatment. This IOP effect was statistically superior (p < 0.05) to timolol. There were no “significant safety findings” in this study.

Nonetheless, as this was a very short evaluation period I would not expect the usual prostaglandin analog side effects to appear so soon. Given time I would imagine that Vesneo (latanoprostene bunod) will exhibit lash growth, iris color change, as well as darkening and tightening of the eyelids as is typical of the prostaglandin analog class of glaucoma medications. Time will tell…

Summary

The prostaglandin analog class of glaucoma medications is one of the most effective at controlling IOP. In theory a drug that is effective at both improving uveoscleral outflow and improving blood flow to the optic nerve would be a welcome addition to currently available glaucoma treatments. Early results of Vesneo (latanoprostene bunod) are promising and will hopefully be supported by longer term studies.

References
  1. Culotta, Elizabeth and Koshland, Daniel E. Jr (1992). “NO news is good news”. Science 258 (5090): 1862–1864.
  2. Stryer, Lubert (1995). Biochemistry, 4th Edition. W.H. Freeman and Company. p. 732.

David Richardson, MD

Medical Director, San Marino Eye

David Richardson, MD is widely recognized as one of the top cataract and glaucoma surgeons in the US and is among an elite group of glaucoma surgeons in the country performing the highly specialized canaloplasty procedure. Morever, Dr. Richardson is one of only a few surgeons in the greater Los Angeles area that performs Micropulse® "Cyclophotocoagulation" (MP3) glaucoma laser surgery. Dr. Richardson graduated Magna Cum Laude from University of Southern California and earned his Medical Degree from Harvard Medical School. He completed his ophthalmology residency at the LAC+USC Medical Center/ Doheny Institute. Dr. David Richardson is also an Adjunct Assistant Professor of Clinical Ophthalmology at Keck School of Medicine of USC. Twice weekly, he treats veterans at the VA Greater Los Angeles Veterans Healthcare System. → Learn more about Dr. David Richardson

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