Netarsudil plus latanoprost cuts diurnal IOP 2.36 mmHg vs latanoprost alone in Japanese glaucoma

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Advances in therapy Published June 1, 2026 Medically reviewed June 1, 2026 Study authors: Aihara Makoto PubMed ↗ DOI ↗ By Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

Key Takeaway

Consider netarsudil plus latanoprost for additional IOP lowering in Japanese glaucoma patients, noting the high conjunctival hyperaemia rate.

This Phase III randomized controlled trial enrolled 246 Japanese participants with primary open-angle glaucoma or ocular hypertension who had inadequate intraocular pressure reduction with latanoprost monotherapy. The multicentre study compared netarsudil 0.02% plus concomitant latanoprost 0.005% against placebo plus latanoprost over a 4-week follow-up.

The primary outcome was mean diurnal intraocular pressure at week 4. The netarsudil plus latanoprost group had a mean pressure of 15.29 mmHg (0.17) versus 17.65 mmHg (0.17) in the placebo plus latanoprost group, a difference of -2.36 mmHg (p < 0.0001). Significant reductions were also seen at weeks 1 (-2.47 mmHg, p < 0.0001) and 2 (-2.41 mmHg, p < 0.0001).

Safety data showed that 64.8% of participants in the netarsudil plus latanoprost group reported adverse events versus 21.0% with placebo plus latanoprost. Conjunctival hyperaemia was the most common adverse event (53.3% vs. 6.5%). No serious adverse events were reported. Discontinuations were not reported.

Key limitations include the short 4-week follow-up and the focus on a Japanese population, which may limit generalizability. The study did not report funding or conflicts of interest. Practice relevance was not reported. These findings suggest a modest additional intraocular pressure reduction with the combination, but tolerability must be monitored.

Study Details

Study typeRct

EvidenceLevel 2

PublishedJun 2026

PMID41915113

View Original Abstract ↓

INTRODUCTION: This prospective, phase III, randomised, multicentre, double-masked study (jRCT2031210122) assessed the intraocular pressure (IOP)-lowering efficacy, tolerability and superiority of netarsudil 0.02% + concomitant latanoprost 0.005% to placebo + latanoprost in Japanese participants with primary open-angle glaucoma (POAG) or ocular hypertension (OHT) who have inadequate IOP reduction with latanoprost monotherapy. METHODS: Participants received latanoprost once daily for 6 weeks. Eligible participants (n = 246) with POAG (n = 165) or OHT (n = 81) were randomised (1:1) to netarsudil + latanoprost (n = 122) or placebo + latanoprost (n = 124) for 4 weeks. Primary endpoint was mean diurnal (MD) IOP at week 4, with superiority demonstrated if the between-group difference in least squares mean MD IOP was < 0 and p < 0.05. Secondary endpoints included MD IOP at weeks 1 and 2. Adverse events (AEs) were recorded. RESULTS: At week 4, MD IOP (standard error) was 15.29 (0.17) versus 17.65 (0.17) mmHg with netarsudil + latanoprost versus placebo + latanoprost, respectively [difference, - 2.36 (p < 0.0001)]. The differences at weeks 1 and 2 between netarsudil + latanoprost and placebo + latanoprost were - 2.47 and - 2.41 (p < 0.0001), respectively. At each visit, netarsudil + latanoprost significantly reduced MD IOP versus placebo + latanoprost (p < 0.0001). Of those receiving netarsudil + latanoprost, 64.8% reported AEs versus 21.0% receiving placebo + latanoprost. Conjunctival hyperaemia was the most reported AE in both groups (53.3% vs. 6.5%). No serious AEs were reported. CONCLUSION: Netarsudil + latanoprost was superior to placebo + latanoprost in lowering elevated IOP in Japanese patients with POAG or OHT. No new safety signals were reported. TRIAL REGISTRATION: Japan registry of clinical trials: jRCT2031210122.