LTHT Drug and Therapeutics Group Summary 0.004% and travoprost 0.004% with 0.5% (Benzylalkonium free) eye drops for patients allergic to benzalkonium chloride

Supported for use

Application summary - 22nd April 2013

• Travaprost is a analogue and is available in a combination with timolol beta-blocker, trade name DuoTrav® • It has been requested for use by the ophthalmologists and their teams in the treatment of chronic open angle glaucoma and in patients who are allergic or intolerant to benzalkonium chloride (BAK). • Travoprost is licensed for ocular hypertension (OH) and chronic open angle glaucoma (COAG). • The combination of travoprost/timolol is licensed for OH and COAG in patients who are uncontrolled by a or beta-blocker. • Travoprost is not for general use in ophthalmology but for patients who are allergic or intolerant to benzalkonium chloride. • This would constitute an addition to the formulary - no products would be removed. • NICE guidelines state prostaglandin analogues should be used first line in COAG and in a sub-group of patients with ocular hypertension but does not state specific drugs. Local guidelines are awaiting approval. • Evidence of efficacy - Travoprost has been shown to be comparable with in meta review analysis. There is one paper showing no difference between benzalkonium containing and polyquatermium-1 containing travoprost and travoprost/timolol eye drops. • The main adverse effects similar to other are hyperaemia and hyper pigmentation being the most common. • The main advantage is that the formulation does not contain benzalkonium chloride. • Cost implications for LTHT will be small as there are limited number of patients and either 1 bottle initial supply or a treatment advice note to GP. • For primary care, travoprost is cheaper than (preservative free preparation). • In addition, travoprost/timolol combination is cheaper than separate preservative free tafluprost and beta-blockers. • Both products are more cost effective when compared with tafluprost and preservative free beta-blockers.

Place in therapy

• Both travoprost and timolol are licensed to decrease elevated intraocular pressure in patients with ocular hypertension or open-angle glaucoma. • One drop is to be used into the affected eye daily. Evidence shows that travoprost shows optimum effect if it is administered in the evening but there is no evidence relating to travoprost/timolol combination administration times. • The combination therapy is licensed for COAG and OH but should be limited to patients who are allergic to or intolerant to benzalkonium chloride. • The licensed indication also includes that treatment should be long term, usually lifelong or until successful glaucoma surgery.

Drug and Therapeutics Decision Summary - 22nd April 2013

• Support for treatment of chronic open angle glaucoma (COAG) or ocular hypertension (OH) in line with NICE CG 85 guideline. • The majority of patients are managed on latanoprost or . • The request is to support the management of patients with an allergy to benzalkonium chloride. • DuoTrav®, a combination of travoprost and timolol eye drops has been reformulated and contains polyquatermium-1. • Management with preservative free products is more expensive and it is proposed that these agents will be placed centrally between benzalkonium chloride containing and preservative free minims. • They are not for general use, the flow diagram in the local guidance outlines the use and this will be available on the netFormulary on Leeds Health Pathways.

Compiled from the original formulary application and the Drug and Therapeutics Committee minutes Harpreet Ghataure, Pre-Registration Pharmacist Dave Abbott, Medicines Information Pharmacist The Leeds Medicines Information Service [email protected]