The Efficacy and Safety Profile of Netarsudil 0.02% in Glaucoma Treatment: Real-World Outcomes

Introduction: More effective glaucoma medications are necessary as medication intolerance and non-adherence remain problematic. Netarsudil is a newly FDA-approved Rho kinase inhibitor. We hypothesize that netarsudil will safely reduce intraocular pressure (IOP) compared to baseline even while other glaucoma medications are used. Methods: This retrospective observational study was conducted on glaucoma patients seen at the Wills Eye Hospital Glaucoma Service who received netarsudil 0.02% between March and September of 2018. Intraocular pressure (IOP, via Goldmann applanation tonometry) and best corrected visual acuity (BCVA, via Snellen visual acuity charts) comparisons between baseline and 1- and 3-month follow-up visits were performed using Student’s t-tests. Results: This study included 172 eyes of 108 patients. Compared to baseline, a mean±SD decrease in IOP of 3.67±4.91 and 3.91±4.83 mmHg was noted at 1- and 3-month follow-up visits, respectively (both p\u3c0.001). No statistically significant difference in IOP change between patients on ≥3 and \u3c3 glaucoma medications at month 1 was observed (p=0.667). Conjunctival hyperemia was the most common side effect at months 1 and 3 (15.7% and 23.0% of patients, respectively). Blurred vision was reported at 1- and 3-month follow-up (5.8% and 8.0% of patients, respectively), but no significant difference in BCVA was observed (p= 0.723 and 0.611, respectively). Discussion: With a mild side effect profile, netarsudil yielded a significant IOP reduction in glaucoma patients, including significant reductions in patients on ≥3 medications. Given its efficacy and unique mechanism of action, earlier-line use of netarsudil may be considered

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes