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Archive March 2019 XX, No. 3

Catching Up With 5 Sustained-Release Drugs

New inserts, implants and injections extend therapy for days or even weeks after surgery.

Jim Burger

Jim Burger, Senior Editor


Welcome to the world of time-release treatments — meds that you administer before or during surgery, but that keep working for days, weeks, months or even years, so your patients don’t have to. From analgesia to ophthalmic therapies, here’s a look at 5 sustained-release drugs that ease the burden of medication adherence and compliance for your patients and your physicians.

Dextenza (Ocular Therapeutix)


Patients are least likely to adhere to drop regimens after eye surgery, so any product that reduces the need for drops is bound to be a welcome addition.

Recently FDA-approved, Dextenza (dexamethasone ophthalmic insert) 0.4mg is a tiny plug that’s inserted into the punctum and canaliculus — “a very straightforward and efficient way of applying the steroid after surgery,” says ophthalmologist I. Paul Singh, MD the Eye Centers of Racine and Kenosha (Wisc.). “What’s unique about having a punctal plug is that it’s not inside the eye. That makes it easier and more efficient for doctors who don’t feel comfortable inserting some other devices intraoperatively. It can be done post-op, pre-op or intra-op, because it’s external to the eye.”

The plug typically stays in for 30 days, delivering a tapered dose of dexamethasone to treat ocular pain after surgery, and alleviating compliance concerns.

“The idea that patients consistently take their steroids 4 times a day for a month is just false,” says John A. Hovanesian, MD, an assistant professor at the UCLA Jules Stein Eye Institute who practices at Harvard Eye Associates in Laguna Hills, Calif. “There’s overwhelming evidence that most patients fail to take drops as directed. Taking the delivery of medicine out of the hands of the patient is really a step in the right direction.”

And if an unlikely complication occurs? “You have the freedom also of being able to take it out if, say, someone has a pressure spike for some strange reason,” says Dr. Singh. “The control you have to modulate, to change it postoperatively, is very important.”

But, as Dr. Hovanesian points out, such a complication may actually be less likely with an implant. “We think pressure spikes with steroids happen because of high intermittent dosing, and there is some evidence to support that,” he says. “With drugs that release a low but steady level of steroid, we don’t really see pressure spikes.”

Dextenza is currently approved for the treatment of surgical pain, but the company is also looking to have it approved for ocular inflammation.

“It’s talked about in terms of cataract surgery,” says Dr. Singh, “but it’s really meant for any post-operative pain.” Ocular Therapeutix has also submitted an application for transitional pass-through payment status and an application for a J-code.

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