Clinical Outcomes of Switching from Prostaglandin Analogs to Omidenepag Isopropyl in Primary Open-Angle Glaucoma and Glaucoma Suspect Patients with Prostaglandin-Associated Periorbitopathy: A Prospective, Multicenter Study

Abstract

Background/Objectives: Prostaglandin-associated periorbitopathy (PAP) is a common treatment-related burden of prostaglandin analog (PGA) therapy that may compromise long-term glaucoma management. This study evaluated improvement in PAP and changes in intraocular pressure (IOP) after switching from PGAs to omidenepag isopropyl. Methods: This prospective, multicenter study was conducted in Korea over 24 weeks. Adults diagnosed with PAP who had received PGA eye drops for ≥3 months for primary open-angle glaucoma, normal-tension glaucoma, or glaucoma suspect were switched to omidenepag isopropyl. PAP manifestations were evaluated using investigator assessments, independent assessments, and patient-reported outcome measures. Changes in IOP and safety outcomes were also assessed. Results: A total of 96 patients were included in the final analysis. At Week 24, improvement in deepening of the upper eyelid sulcus was observed in 78.16% of patients. Improvements were also observed in flattening of the lower eyelid bag, upper eyelid ptosis, ciliary hypertrichosis, and periorbital hyperpigmentation. Mean IOP was significantly reduced from baseline (−2.14 mmHg), with 42.71% and 27.08% of patients achieving IOP reductions of ≥15% and ≥20%, respectively. Findings were consistent overall across institutional, independent, and subjective assessments. Most adverse events were mild, and no serious adverse events were reported. Conclusions: PAP manifestations improved following transition from PGA therapy to omidenepag isopropyl, while IOP control and favorable tolerability were maintained in glaucoma or glaucoma suspect patients with PAP. These findings may support the clinical feasibility of switching from PGAs to omidenepag isopropyl in patients with PAP.