Prostaglandin E2 inhibition of ketorolac 0.45%, bromfenac 0.09%, and nepafenac 0.1% in patients undergoing phacoemulsification

Adv Ther. 2011 Dec;28(12):1089-95. doi: 10.1007/s12325-011-0080-7. Epub 2011 Nov 18.

Abstract

Introduction: We compared the prostaglandin E(2) (PGE(2)) inhibition of three topical nonsteroidal antiinflammatory drugs (NSAIDs): ketorolac 0.45%, bromfenac 0.09%, and nepafenac 0.1% at peak dosing levels in patients previously scheduled to undergo phacoemulsification.

Methods: This was a single-center, double-masked observational study of 121 patients randomized to one of three NSAID treatment arms. Patients were instructed to take the NSAID per on-label dosing (twice daily [b.i.d.] for ketorolac 0.45% and bromfenac 0.09%, three times a day [t.i.d.] for nepafenac 0.1%) for 1 day before surgery, and were to instill one drop the morning of surgery. Each patient received an additional four doses 1 hour prior to undergoing phacoemulsification. After completion of the paracentesis site with a super blade, aqueous humor (0.15 mL) was collected through the peripheral clear cornea with a 30 G needle attached to a tuberculin (TB) syringe. Aqueous humor samples were stored at -40°C prior to analysis, and diluted 1:10 with diluent. Assays were conducted on multiple plates in duplicate (seven standards per plate).

Results: The mean (±SD) PGE(2) concentrations were 224.8±164.87 pg/mL for ketorolac 0.45% (n=42), 288.7±226.05 pg/mL for bromfenac 0.09% (n=41), and 320.4±205.6 pg/mL for nepafenac 0.1% (n=38). The difference between ketorolac 0.45% and nepafenac 0.1% was statistically significant (P=0.025). The difference between bromfenac 0.09% and nepafenac 0.1% was not significantly different (P=0.516).

Conclusions: Ketorolac 0.45% achieved the greatest inhibition of PGE(2) compared to nepafenac 0.1% and bromfenac 0.09%. Ketorolac 0.45% may be more efficacious at controlling inflammation at the time of cataract surgery versus nepafenac 0.1% and bromfenac 0.09%.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Inflammatory Agents, Non-Steroidal / pharmacology*
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Benzeneacetamides / pharmacology*
  • Benzeneacetamides / therapeutic use
  • Benzophenones / pharmacology*
  • Benzophenones / therapeutic use
  • Bromobenzenes / pharmacology*
  • Bromobenzenes / therapeutic use
  • Dinoprostone / antagonists & inhibitors*
  • Dinoprostone / metabolism
  • Double-Blind Method
  • Female
  • Humans
  • Ketorolac / pharmacology*
  • Ketorolac / therapeutic use
  • Male
  • Middle Aged
  • Ophthalmic Solutions / pharmacology
  • Ophthalmic Solutions / therapeutic use
  • Phacoemulsification / methods*
  • Phenylacetates / pharmacology*
  • Phenylacetates / therapeutic use

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Benzeneacetamides
  • Benzophenones
  • Bromobenzenes
  • Ophthalmic Solutions
  • Phenylacetates
  • nepafenac
  • bromfenac
  • Dinoprostone
  • Ketorolac