Netarsudil

Evidence Level: L5

Predicted Indications: 10

Netarsudil
Netarsudil: From Open-Angle Glaucoma and Ocular Hypertension to Primary Hereditary Glaucoma

## Pharmacist Assessment Report

Netarsudil: From Open-Angle Glaucoma and Ocular Hypertension to Primary Hereditary Glaucoma

One-Sentence Summary

Netarsudil is a topical eye drop originally used to lower eye pressure in open-angle glaucoma and ocular hypertension. The TxGNN model predicts it may be effective for primary hereditary glaucoma, but no clinical trials and no publications were found for this specific condition, so the prediction rests on model output alone.

Quick Overview

Item	Content
Original Indication	Open-angle glaucoma; ocular hypertension
Predicted New Indication	Primary hereditary glaucoma
TxGNN Prediction Score	99.50%
Evidence Level	L5
Singapore Market Status	✓ Marketed
Number of Registrations	2
Recommended Decision	Hold

Why is This Prediction Reasonable?

Netarsudil inhibits Rho kinase (ROCK1 and ROCK2) and the norepinephrine transporter. By relaxing the trabecular meshwork, it increases the eye's natural fluid drainage. It also reduces pressure in the episcleral veins and fluid production in the eye, which together lower intraocular pressure (IOP).

Lowering IOP is the main treatment strategy across glaucoma types, including glaucoma with a genetic cause. That is why the model links netarsudil to primary hereditary glaucoma. The link is plausible in principle, but nobody appears to have tested netarsudil in this specific group.

For context, the closely related predictions "glaucoma", "glaucoma 1, open angle" and "open angle glaucoma" are essentially the drug's approved use. These are backed by multiple completed Phase 3 trials, including the ROCKET and MERCURY programmes. They are not new repurposing findings, and they do not confirm efficacy in hereditary glaucoma.

Clinical Trial Evidence

Currently no related clinical trials registered for primary hereditary glaucoma.

Literature Evidence

Currently no related literature available for primary hereditary glaucoma.

Singapore Market Information

Authorization Number	Product Name	Dosage Form	Approved Indication
SIN16816P	Rhopressa Ophthalmic Solution, 0.02% w/v	Sterile solution	Not stated in the data compiled for this report
SIN16818P	Rocklatan Ophthalmic Solution, 0.02% w/v / 0.005% w/v	Sterile solution	Not stated in the data compiled for this report

Both authorizations are currently valid and held by Aerie Pharmaceuticals Ireland Limited. Rocklatan combines netarsudil with latanoprost.

Safety Considerations

Please refer to the package insert for safety information.

In the published literature on netarsudil in approved glaucoma use, reported ocular adverse events include:

Conjunctival hyperemia
Corneal verticillata and epithelial keratopathy
Corneal edema
Conjunctival fragility
Punctal stenosis

These would need monitoring in any new patient group. Safety in children has not been established, and this matters for hereditary glaucoma, which can present early in life.

Conclusion and Next Steps

Decision: Hold

Rationale: The prediction is mechanistically plausible but supported only by the model score, with no trials or publications for primary hereditary glaucoma. Netarsudil's proven effect on IOP in open-angle glaucoma does not by itself establish benefit in genetically caused glaucoma.

To proceed, the following is needed:

Mechanism-of-action data from a curated source such as DrugBank
Package insert warnings and contraindications from the HSA website
Evidence in hereditary or genetically defined glaucoma populations, such as case series, registry data or an exploratory trial
A paediatric and young-adult safety assessment, if these patients are in scope
Expert ophthalmology input on how a topical IOP-lowering drug would fit alongside existing medical and surgical care
Disclaimer

This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.