Benefits of Preservative-Free Latanoprost vs BAK-Containing Formulation Investigated

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This article is part of MPR’s coverage of the American Academy of Ophthalmology 2019 Meeting, taking place in San Francisco, CA. Our staff will report on medical research related to eye disorders, conducted by experts in the field. Check back regularly for more news from AAO 2019.

SAN FRANCISCO – Preservative-free latanoprost proved to be as effective but more tolerable than the benzalkonium chloride-containing formulation, according to research presented at the American Academy of Ophthalmology (AAO) 2019 Annual Meeting, held October 12-15, 2019 in San Francisco, California.

Benzalkonium chloride (BAK), the preservative in latanoprost, has been implicated in significant ocular side effects including conjunctival hyperemia. To examine the differences in tolerability and efficacy between the first preservative-free latanoprost eye drops (Xelpros; Sun Pharma) and the BAK-containing formulation (Xalatan; Pfizer), researchers performed a mixed-pooled analysis of cumulative data from randomized controlled trials and real-world evidence. The primary end point was the improvement of conjunctival hyperemia. Secondary endpoints include reduction in intraocular pressure (IOP) from baseline to Day 84, a 5-parameter composite Ocular Surface Disease (OSD) score, adverse events, and patient satisfaction. 

Results showed that preservative-free latanoprost was associated with twice as much reduction in conjunctival hyperemia compared with preserved latanoprost (P <.001). No significant difference in IOP-lowering efficacy after 84 days was observed between the 2 formulations. An improvement in the the 5-parameter composite OSD score was also reported  (−6.8 vs −2.6; P <.001). 

Xelpros, the first BAK-free formulation of latanoprost, was developed using proprietary Swollen Micelle Microemulsion technology, which may reduce the risk of BAK-associated ocular surface disease.


Harasymowycz PJ. Improvement in signs and symptoms of OSD with preservative-free vs. preserved latanoprost: a mixed-pooled analysis. Presented at: The American Academy of Ophthalmology (AAO) 2019 Annual Meeting; October 12-15, 2019; San Francisco, California. Abstract PO177.