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

Abstract

Background: 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, I 2 = 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, I 2 = 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, I 2 = 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, I 2 = 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, I 2 = 76%, 95% CI, 16 to 88, P = 0.002). Conclusion: Randomized head-to-head evaluations of prostaglandin therapy demonstrate similar efficacy effects, but differing hyperemia effects.

Efficacy and tolerability of mono-compound topical treatments for reduction of intraocular pressure in patients with primary open angle glaucoma or ocular hypertension: an overview of reviews

“…They were published between 2000 and 2010. Most (10/16) were focused on both efficacy and tolerability/safety (as a secondary objective) ( 29 , 31 , 33 - 38 , 40 , 43 ), five addressed only efficacy ( 28 , 30 , 32 , 39 , 42 ), and one addressed exclusively local tolerability, specifically conjunctival hyperemia ( 41 ). Two reviews ( 42 , 43 ) synthesized data using network meta-analysis, whereas others were declared as “classical” meta-analyses.…”

“…Considering the inclusion/exclusion criteria for primary studies combined with the displayed structures of the embraced patients (in the primary studies), it is safe to conclude that all other reviews assessed the treatments in the setting of (predominantly) POAG/OHT. Only 1/16 reviews included, among the primary studies, several non-randomized trials (4/16) ( 40 ). All other primary trials in all other reviews were RCTs, although 2 reviews intended to include also quasi-randomized trials ( 33 , 37 ).…”

“…Table 4 summarizes point-estimates of pair-wise differences in IOP reduction reported by Orme et al ( 43 ). Assuming that the limits of -1.0 to +1.0 mm Hg for IOP reduction are reasonable limits of therapeutic equivalence ( 40 ), the three PGAs appear to be equivalent. In a series of pair-wise comparisons, Aptel et al ( 34 ) calculated somewhat larger differences between bimatoprost and latanoprost, and between bimatoprost and travoprost – but still, all were well within the -1.0 to +1.0 range.…”

“… *We assumed that the limits of -1.0 to +1.0 mm Hg for a difference in IOP reduction could be reasonably accepted as limits of equivalence ( 40 ). †IOP – intraocular pressure; BB – beta blockers; CAI – carbonic anhydrase inhibitors; w/o – without.…”

Managing adverse effects of glaucoma medications

“…However, it was less likely to occur with travoprost (relative risk =0.82 times) than with bimatoprost. 24 …”