Comparison of the effects of travoprost, latanoprost and bimatoprost on ocular circulation: a 6‐month clinical trial

Abstract

ABSTRACT.Purpose: To study the effect of three prostaglandin F 2 -a (PG) analogues on retrobulbar blood flow velocity in previously untreated patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT), using colour Doppler ultrasound. Methods: Sixty newly diagnosed patients with POAG or OHT were randomly assigned to travoprost 0.004% (n ¼ 12 with POAG, n ¼ 8 with OHT), latanoprost 0.005% (n ¼ 11 with POAG, n ¼ 9 with OHT) and bimatoprost 0.03% (n ¼ 13 with POAG, n ¼ 7 with OHT) treatment groups in a double-masked fashion. At baseline examination, blood pressure, heart rate and intraocular pressure (IOP) were recorded. Peak-systolic and end-diastolic velocities were measured in the ophthalmic (OA), central retinal (CRA) and temporal short posterior ciliary arteries (PCA). The resistive index (RI) and ocular perfusion pressure (OPP) were determined for each treatment group. After a treatment period of 6-months, all procedures were repeated. Results: There were no significant differences in age (53 ± 14 years in the travoprost group, 51 ± 14 years in the latanoprost group, 53 ± 11 years in the bimatoprost group), gender (11 men, nine women; 11 men, nine women; 13 men, seven women, by group, respectively), or clinical diagnosis (POAG or OHT) among treatment groups (p > 0.05). A significant decrease in IOP (baseline: 26.4 ± 3.3 mmHg, 26.8 ± 1.3 mmHg, 25.8 ± 1.8 mmHg, respectively; month 6: 20.9 ± 1.9 mmHg, 20.8 ± 2.4 mmHg, 18.3 ± 1.2 mmHg, respectively; p < 0.0001) and an increase in OPP (baseline: 33.7 ± 3.8 mmHg, 33.5 ± 3.2 mmHg, 33.9 ± 2.6 mmHg, respectively; month 6: 40.2 ± 3.5 mmHg, 39.9 ± 3.1 mmHg, 41.7 ± 2.6 mmHg, respectively; p < 0.0001) were verified in all three groups during the study period. Mean baseline RI values for the CRA in the travoprost group and the OA in the latanoprost group were both 0.7 ± 0.1 mmHg and both values were statistically significantly lower at 6 months (0.6 ± 0.1 mmHg in both groups; p ¼ 0.002, p < 0.0001, respectively). In the bimatoprost group there was no statistically significant difference in haemodynamic parameters over the study period (p > 0.05). Conclusions: Our results suggest that the three PG analogues significantly reduce IOP and increase OPP in patients with POAG or OHT. Topical travoprost and latanoprost significantly reduce the RI of the CRA and OA, respectively. We were unable to determine any effect of topical bimatoprost on ocular haemodynamics.

Efficacy and safety of prostaglandin analogues in patients with predominantly primary open-angle glaucoma or ocular hypertension: a meta-analysis

“…Figure 1 presents details of the exclusion criteria at the various stages during the study selection process. Five trials had more than 2 intervention arms, 28 [28][29][30][31][32][39][40][41] We did not pool the data from one trial, reported as an abstract, as we were unable to determine the group sizes. 42 Table 1 and 2 report the study characteristics and quality (see Tables 1 and 2).…”

Effect of travoprost on 24-hour intraocular pressure in normal tension glaucoma

“…[25][26][27] Among the topical antiglaucoma eye drops, the prostaglandin F2-alpha analogs (travoprost, latanoprost, and bimatoprost) and dorzolamide increase OPP, whereas timolol, a beta-blocker, and brimonidine do not. [28][29][30] Therefore, to investigate the effect of eye drops, both the reduction in IOP and the hemodynamic effects of the medication should be evaluated.…”

Clinical utility and differential effects of prostaglandin analogs in the management of raised intraocular pressure and ocular hypertension

“…55 A randomized double-masked crossover study 56 found a more favorable effect on ocular perfusion pressures (OPP) (which are directly related to OBF) with latanoprost than timolol. 56 Using color Doppler ultrasound, Koz et al 57 demonstrated that latanoprost, travoprost and bimatoprost increased blood flow velocity and OPP, and latanoprost and travoprost decreased the resistive index of the ophthalmic artery and central retinal artery (CRA). Alagoz et al 58 found increased CRA blood flow with bimatoprost and travoprost use.…”

“…68 Several meta-analyses [88][89][90][91] have directly compared the clinical efficacy of the three main PGAs, latanoprost, travoprost, and bimatoprost. Two independent meta-analyses, one 88 of 8 63,64,68,78,[85][86][87]92 and the other 89 of 13 trials (including double-blind parallel 57,63,93 or cross-over studies 41,42 and single blind parallel 64,78,85,86,[94][95][96] or cross-over studies) 97 found bimatoprost was superior to latanoprost in lowering morning IOP at all time points, supported by a later posthoc meta-analysis of 2 independent trials with 6 months follow-up. Weighted mean difference (WMD) for %IOP reduction (%IOPR) was 2.59% (P = 0.004) at 1 month to 5.60% (P , 0.001) at 6 months for one meta-analysis 89 and weighted mean (WM) IOP change from baseline ranged from a minimum of 0.50 mmHg (P = 0.05) at 0800 hours to a maximum of 1.17 mmHg (P , 0.001) at 1200 hours in the other meta-analysis 88 favoring bimatoprost over latanoprost.…”

“…Bimatoprost was superior in IOP lowering to travoprost only during the daytime (0800 and 1200 hours time-points), but latanoprost and travoprost were comparable at all time points (P # 0.82). 88 An industry-sponsored meta-analysis 90 of travoprost vs latanoprost (15 trials, n = 1098), 57,68,85,93,95,96,[98][99][100] travoprost vs bimatoprost (8 trials, n = 714), 57,85,87,93,95,96,101,102 and latanoprost vs bimatoprost (8 trials, n = 943) 57,64,85,86,93,95,96,103 found similar efficacy among the three PGAs. Studies comparing the PGA to other non-PGA glaucoma treatments, nonrandomized, dose-finding or cross-over trials, and short-term evaluations (less than 3 months) were excluded, although a trial evaluating timolol plus travoprost versus timolol alone, 100 was included indicating that the PGA effect has the same relative effect as if it were compared with no treatment.…”