About glaucoma
Glaucoma is the second leading cause of blindness in the world. It is mainly because the fluid, the aqueous humor, in the eyeball cannot be drained normally. This causes an increase in intraocular pressure (IOP), leading to damage to the optic neuropathy, and then optic nerve atrophy. There are no symptoms in the early stage. In the moderate to severe stages, the patient begins to lose peripheral vision due to damage to the optic nerve. If not treated immediately, the visual field will slowly shrink from the edges until the central vision disappears. This is a chronic and irreversible optic neuropathy process.
The causes of glaucoma vary and are mainly divided into two categories. One is increased IOP, and the other is poor blood circulation of the optic nerve. High-risk factors include elevated IOP caused by high myopia or hyperopia, age older than 40 years, family history of glaucoma, long-term use of steroids, anti-epileptic drugs, or psychiatric drugs, systemic chronic diseases such as diabetes, cardiovascular disease, and hypo-/hypertension, etc., other eye diseases such as intraocular inflammation, eyeball trauma, or intraocular surgery, etc.
According to WHO (2019), there will be approximately 76 million glaucoma patients in 2020, which is estimated to grow to 95.4 million patients by 2030. It is estimated that the overall number of patients will grow at a compound annual growth rate (CAGR) of 2.3% between 2020 and 2030. According to the Ophthalmology Department of Taichung Veterans General Hospital, there are currently approximately 80 million people with glaucoma worldwide, including more than 340,000 glaucoma patients in Taiwan.
BRM411：dual target inhibitor with minimal side effect
INDICATION
Glaucoma
MECHANISM
Best-in-class, dual target ROCK/MYLK-4 inhibitor that can reduce IOP with minimal hyperemia
ADVANTAGES
- Dual target inhibitor to effectively treat high IOP patients (>26mmHg)
- Once daily at night to reduce hyperemia
MARKET
- Growing patient population with unmet need
- Global market of USD ~ 6.11 billion in 2023, and projected to be USD ~8.45 billion in 2033
COMPETITION
- Glanatec (JP only) and Rhopressa are the other 2 marketed ROCK inhibitors.
- There are long-acting devices also in development.
DEVELOPMENT STAGE
Next Phase 2 is scheduled to be initiated this year
The treatment of glaucoma mainly focuses on reducing IOP to delay the degeneration of optic nerve function through drugs, lasers, or surgery. In terms of drug treatment, there are prostaglandin analogs (PGAs), β Blockers, adrenergic agonists, carbonic anhydrase inhibitors, etc. However, patient compliance is low due to side effects, such as dark circles, deepening of iris color, longer eyelashes, and red eyes. Also, after long-term use, some patients will develop drug resistance, and the IOP-lowering effect will gradually decrease, which also makes patients reduce their willingness to receive treatment.
The ROCK inhibitors, Rhopressa, and its combo with PGAs, Rocklatan, are the new generation of glaucoma drugs gaining approval in the United States developed by Aerie. The main component is a small molecule drug that can specifically inhibit Rho-associated protein kinase (ROCK). ), which can increase the elimination of aqueous humor through the trabecular meshwork (TM) of the eye. However, for patients with IOP higher than 26mmHg, the drug’s blood pressure-lowering effect is limited, and more than 50% of patients have the side effect of red eyes, so the market expansion is relatively limited.
BRM411 is a dual-target inhibitor of ROCK/MYLK-4. It can effectively control IOP and is also effective for patients with high IOP (>26mmHg). It only needs to be taken once a day before sleep, and the proportion of red eyes during the day will be reduced. Once it is approved, BRM411 can provide another effective treatment option for glaucoma patients.
