What is Brinsupri?

Brinsupri: A Novel Medication for Glaucoma and Ocular Hypertension

Brinsupri is a fixed-combination ophthalmic medication containing brinzolamide 1% and brimonidine 0.2%, used for reducing intraocular pressure in patients with open-angle glaucoma or ocular hypertension.

Mechanism of Action

• Brinzolamide is a highly specific carbonic anhydrase II (CA-II) inhibitor that lowers intraocular pressure (IOP) by reducing aqueous humor formation in the eye 1
• Brimonidine is a selective alpha-2 adrenergic receptor agonist that reduces IOP through two mechanisms: decreasing aqueous humor production and increasing uveoscleral outflow 2, 3
• The combination provides a dual mechanism of action that offers greater IOP reduction than either component alone 4

Clinical Efficacy

• In phase III clinical trials, Brinsupri demonstrated significantly greater IOP-lowering efficacy than either brinzolamide or brimonidine used as monotherapy 4
• When administered twice daily, Brinsupri was shown to be noninferior to concomitant administration of its individual components over a 6-month period 4
• Brinzolamide alone typically reduces IOP by approximately 15-20%, making it an effective component of this combination therapy 1, 5

Advantages and Unique Features

• Brinsupri is the first available fixed-combination glaucoma medication that does not contain timolol (a beta-blocker), making it particularly suitable for patients with contraindications to beta-blockers 4
• The combination provides a convenient alternative for patients requiring multiple IOP-lowering medications, improving adherence through reduced dosing complexity 4
• Some evidence suggests brimonidine may have neuroprotective effects on retinal ganglion cells independent of its IOP-lowering action, potentially offering additional benefits in glaucoma management 2

Safety Profile and Adverse Effects

• Common ocular adverse events include:
  • Conjunctival hyperemia (redness) in approximately 11-26% of patients 2, 3
  • Ocular discomfort or pain 1, 5
  • Blurred vision (3-8% of patients) 1
  • Ocular pruritus (itching) 2
• Systemic side effects may include:
  • Oral dryness (reported in up to 30% of patients using brimonidine) 3
  • Minimal cardiovascular effects, though caution is advised in patients with severe cardiovascular disease 3

Patient Selection Considerations

• Ideal candidates include:
  • Patients with open-angle glaucoma or ocular hypertension who require multiple medications for adequate IOP control 4
  • Patients with cardiopulmonary conditions that contraindicate beta-blocker use 4, 3
  • Patients who have not achieved sufficient IOP reduction with monotherapy 4

Monitoring and Administration

• Typically administered as eye drops twice daily 4
• Regular monitoring of IOP response is essential to ensure therapeutic efficacy
• Patients should be monitored for ocular allergic reactions, which can occur in approximately 9-10% of patients using brimonidine 3

Limitations and Precautions

• Not indicated for tuberculosis treatment, as it is not included in any recommended TB treatment protocols 6
• Should be used with caution in patients with severe cardiovascular disease 3
• May not be suitable for all patients due to potential for allergic reactions to either component