Glaucoma is the leading cause of irreversible vision loss worldwide. Open-angle glaucoma is the most typical form, accounting for 90% of all cases, and is in most cases chronic. All glaucoma subtypes are characterised by retinal ganglion cell death, which results in a cupping of the optic nerve head, leading to vision loss. Raised intraocular pressure (IOP) is the primary risk factor for glaucoma and, due to this, conventional topical treatments work to lower IOP to stop disease progression.

Conventional drug classes for glaucoma include prostaglandin analogues (PGAs), beta-blockers, alpha-adrenergic agonists and carbonic anhydrase inhibitors. Many pharmaceutical companies in recent years, however, have focused on developing products outside of the conventional classes for glaucoma treatment to provide a new mechanism of action to reduce IOP that can be utilized adjunctively to existing treatments. Examples are Rho-kinase inhibitors such as Rhopressa and Glanatec, which have generated a lot of interest in recent years. There are also small-interfering RNA (bamosiran) and LRRK2-targeting (h-1337) products currently in the pipeline. Glaucoma is an established indication, however, with large numbers of treatments that have become available over the years. PGAs remain the first-line treatment due to their superior efficacy, safety and low cost because of the large number of generics available. Due to this, it is highly unlikely that a new treatment class will overtake PGAs as a first-line treatment until 2030 as a result of the highly competitive nature of the market.

The glaucoma market’s mature nature means there is a low level of unmet need with the disease, but some unmet need remains. The greatest unmet need is patient compliance, as patients often do not adhere to complex treatment regimens for glaucoma, with many individuals often requiring multiple drops a day. As a result, pharmaceutical companies have begun looking at optimising administration methods. One way is via the development of sustained-release (SR) implants, which can routinely self-administer the active ingredient into the patients’ eyes. Current SR implants being developed by pharmaceutical companies are Ocular Therapeutix ’s otx-tp and ViSci ’s latanoprost SR. These implants would prove to be significantly beneficial as they would allow patients to be easily treated for a period of three to six months.

Other novel pipeline drugs in late-stage development include NicOx SA’s ncx-470 and Santen Pharmaceutical ’s sepetaprost. Both products are within the PGA drug class, but they possess unique functionalities that may make them a more desirable treatment option than pre-existing eye drops. Ncx-470 functions as a nitric oxide-donating bimatoprost analogue while sepetaprost is the first PGA to act on multiple receptors. Because of this, GlobalData anticipates new treatments and optimised methods of administration to drive the market’s continued growth.