Efficacy and safety of different regimens for primary open‐angle glaucoma or ocular hypertension: a systematic review and network meta‐analysis

Abstract

PurposeTo assess the efficacy and safety of different regimens, including monotherapy and double therapy, for primary open‐angle glaucoma (POAG) or ocular hypertension.MethodsWe searched PubMed, EMBASE and clinicaltrials.gov for studies that fit our inclusion criteria in this network meta‐analysis. Randomized controlled trials that report data on efficacy and safety of medications for POAG or ocular hypertension are included. Data on intra‐ocular pressure (IOP) lowering effect and incidence of adverse events including hyperaemia and ocular discomfort were extracted and used in mixed‐comparison analysis.ResultsThis study includes 72 randomized trials. Data were available on 12 medical treatments of POAG or ocular hypertension. Of 66 possible comparisons of outcome efficacy, 15 treatments were compared directly. Compared to prostaglandin analogues (PGA), beta‐blockers (BB) showed relatively weaker ability to lower IOP, followed by α2‐adrenergic agonists (AA) and carbonic anhydrase inhibitors (CAI). For dual therapy, regimens composed of a combination of PGA with another treatment demonstrated more powerful IOP lowering efficacy, while the combination of two non‐PGA drugs had lower efficacy in controlling IOP than PGA alone. There was no statistical significance in combinations that did not include PGA on efficacy of IOP control. In terms of tolerance, PGA alone leads to more severe hyperaemia than any other monotherapy regimen, while BBs have the lowest effect on the incidence of hyperaemia. Most dual therapy regimens containing PGA also lead to serious hyperaemia, with the exception of PGA + AA. Compared to regimens containing PGA, those with BB are less likely to cause hyperaemia.ConclusionOur network meta‐analysis showed that PGAs provide best IOP lowering effect among all the monotherapy regimen. Combination of PGA and other category of drugs leads to better IOP decrease. Combination of BB and another non‐PGA drug may have less ocular side‐effects than PGA alone.

The changes of corneal biomechanical properties with long-term treatment of prostaglandin analogue measured by Corvis ST

“…PGA is the most widely used first-line therapeutic medication for POAG due to its highest effectiveness in decreasing IOP [19] and reducing circadian IOP fluctuations, as well as its convenient dosing and tolerable side effects [20]. However, PGA was found to have some other effects, such as decreasing the thickness of central cornea.…”

Impact of the Severities of Glaucoma on the Incidence of Subsequent Dementia: A Population-Based Cohort Study

“…In the subgroup analysis of the current study, no significant difference is found about the rate of dementia in different subtypes of glaucoma compared to propensity score-matching subjects without glaucoma. The mechanisms of the three subtypes of glaucoma included in the current study are different; the ACG is caused by the acute elevation of intraocular pressure, while the OAG and the NTG are resulted from long-term ocular hypertensive status and possible low-perfusion condition [28,33,34]. That the incidence of dementia did not elevate in all subtypes of glaucoma may further indicate the different pathophysiologies of neurological degradation between the brain and retina, which is supported by the findings of the current study.…”

The changes of corneal biomechanical properties with long-term treatment of prostaglandin analogue measured by Corvis ST

“…PGA is the most widely used rst-line therapeutic medication for POAG due to its highest effectiveness in decreasing IOP [19] and reducing circadian IOP uctuations, as well as its convenient dosing and tolerable side effects [20]. However, PGA was found to have some other effects, such as decreasing the thickness of central cornea.…”