Efficacy and safety of prostaglandin analogues in patients with predominantly primary open-angle glaucoma or ocular hypertension: a meta-analysis
Efficacy and safety of prostaglandin analogues in patients with predominantly primary open-angle glaucoma or ocular hypertension: a meta-analysis
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Oghenowede Eyawo1, Jean Nachega2,3, Pierre Lefebvre4, David Meyer5, Beth Rachlis6, Chia-Wen Lee7, Steven Kelly7, Edward Mills81Faculty of Health Sciences, Simon Fraser University, Vancouver, copyright; 2Division of Clinical Pharmacology and Medicine, University of Cape Town, Cape Town, South 3 piece horse wall art Africa; 3Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; 4Department of Ophthalmology, Moorfields Eye Hospital, London, United Kingdom; 5Department of Ophthalmology, Stellenbosch University, Cape Town, South Africa; 6Department of Public Health, University of Toronto, Toronto, copyright; 7Outcome Research and Evidence Based Medicine, copyright Ltd UK.Tadworth, UK; 8Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, CanadaBackground: First-line therapy for primary open-angle glaucoma and ocular hypertension generally involves prostaglandin analogue therapy.The relative efficacy of differing prostaglandin therapy is disputed.Methods: A meta-analysis was conducted of head-to-head randomized trials of prostaglandin therapies.
We included randomized trials assessing head-to-head evaluations of prostaglandin analogues travoprost, latanoprost and bimatoprost in patients with predominantly primary open-angle glaucoma or ocular hypertension.Findings were interpreted in light of equivalence margins.Results: Our search identified 16 eligible trials, of which 15 were included in the meta-analysis.Trials were, in general, poorly reported.
We pooled 9 trials assessing IOP-lowering effects of travoprost vs latanoprost (total n = 1098, weighted mean difference [WMD], –0.24 mmHg, 95% CI, –0.87 to 0.38, P = 0.
45, I2 = 56%, 95% CI, 0 to 0.77, heterogeneity P = 0.01).Eight trials assessed travoprost vs bimatoprost (total n = 714, WMD, 0.
88 mmHg, 95% CI, 0.13 to 1.63, P = 0.02, I2 = 56%, 95% CI, 0% to 78%, heterogeneity P = 0.
02).And 8 trials assessed latanoprost vs bimatoprost (total n = 943, WMD, 0.73 mmHg, 95% CI, 0.10 to 1.
37, P = 0.02, I2 = 47%, 95% CI, 0% to 74%, heterogeneity P = 0.06).Travoprost was associated with greater incidence of conjunctival hyperemia than latanoprost (RR 5.
71, 95% CI, 1.81 to 18.02, P ≤ 0.001, I2 = 97%, 95% CI, 95 to 98, P ≤ 0.
001).Five trials assessing latanoprost and bimatoprost revealed an elevated risk of conjunctival hyperemia with bimatoprost (RR 1.59, 95% CI, 1.02 to 2.
48, P = 0.04, I2 = 76%, 95% CI, 16 to 88, P = read more 0.002).Conclusion: Randomized head-to-head evaluations of prostaglandin therapy demonstrate similar efficacy effects, but differing hyperemia effects.
Keywords: prostaglandin analogues, primary open-angle glaucoma, ocular hypertension, travoprost, latanoprost, bimatoprost.