Published: 2018-10-23

Netarsudil: a novel intra-ocular pressure lowering agent

Ravi R. Ghanghas, Prafull Mohan, Vikrant Sharma, Ashok K. Sharma


Optic disc health is an important indicator of visual functions. The first line of management to prevent/halt the damage to optic disc is to control responsible pathological condition, if identified. In absence of identifiable cause, the most validated approach is lowering of intra-ocular pressure (IOP). Individually, as well as combinations of currently available drugs are not fully effective in all patients of glaucoma in achieving desired IOP control. Hence, there is a need of newer alternatives which address this unmet need. Recently, a newer IOP lowering agent with a novel mechanism of action, netarsudil, has been approved by United States Food and Drug Administration (US-FDA) in December 2017. Netarsudil acts by inhibiting Rho-associated protein kinase resulting in lowering of overall tone of the contractible cells in trabecular meshwork thereby improving drainage of aqueous humor outflow and lowering of IOP. Though in its early days, this drug gives an armamentarium to ophthalmologists and physicians to control IOP in patients of open-angle glaucoma and ocular hypertension.


Intra-ocular pressure, Netarsudil, Rho kinase inhibitor

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Section VI. Diseases of the Optic Nerve. In: Sihota R, Tandon R eds. Parsons’ Textbook of Diseases of the Eye. 22nd Ed. New Delhi, India: Elsevier; 2015:348-372.

Weinreb R, Aung T, Medeiroset F. The Pathophysiology and Treatment of Glaucoma: A Review. JAMA. 2014;311(18):1901-11.

Collaborative Normal-Tension Glaucoma Study Group. Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures. Am J Ophthalmol. 1998;126(4):487-97.

Boland MV, Ervin AM, Friedman DS, Jampel HD, Hawkins BS, Vollenweider D, et al. Comparative effectiveness of treatments for open-angle glaucoma: a systematic review for thre US Preventive Services Task Force. Ann Intern Med. 2013;158(4):271-9.

Netarsudil - Drug prescribing information (FDA label) Available at: Accessed 30 September 2018

Rao, PV, Pattabiraman, PP, Kopczynski, C. Role of the Rho GTPase/Rho kinase signaling pathway in pathogenesis and treatment of glaucoma: bench to bedside research. Exp Eye Res. 2017;158:23-32.

Ren R, Li G, Le TD, Kopczynski C, Stamer WD, Gong H. Netarsudil increases outflow facility in human eyes through multiple mechanisms. Invest Ophthalmol Vis Sci. 2016;57(14):6197-209.

Kazemi A, McLaren, Kopczynski, Heah TG, Novack GD, Sit AJ. The Effects of Netarsudil Ophthalmic Solution on Aqueous Humor Dynamics in a Randomized Study in Humans. J Ocul Pharmacol Ther. 2018;34(5):380-6.

Lin CW, Sherman B, Moore LA, Laetham CL, Lu DW, Pattabiraman PP, et al. Discovery and preclinical development of netarsudil, a novel ocular hypotensive agent for the treatment of glaucoma. J Ocul Pharmacol Ther. 2018;34(12):40-51.

Serle JB, Katz LJ, McLaurin E, Heah T, Ramires-Davis N, Usner DW, et al. Two Phase 3 clinical trials comparing the safety and efficacy of netarsudil to timolol in patients with elevated intraocular pressure. Am J Ophthalmol. 2018;186:116-27.

Khouri AS, Heah T, Kopczynski C, Novack GD. A double masked, randomized, parallel study of netarsudil ophthalmic solution, 0.02% QD compared to timolol maleate ophthalmic solution, 0.5% BID in patients with elevated intraocular pressure (ROCKET-4). Paper presented at; 2017. Annual Meeting of The Association for research in Vision and Ophthalmology; May 7-11, 2017; Baltimore, MD.