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

Abstract

AimTo evaluate the existing evidence on relative efficacy and tolerability of topical mono-compound intraocular pressure (IOP)-lowering drugs in treatment of primary open angle glaucoma (POAG) and ocular hypertension (OHT).MethodsIn this systematic review of systematic reviews/meta-analyses of randomized controlled trials a thorough and sensitive search of PubMed, Embase and Cochrane Databases was performed. Individual study methodological quality and quality of evidence were assessed using the AMSTAR checklist and the GRADE system, respectively. The relationships between individual drugs were evaluated based on the best available evidence.ResultsOf the 133 initial non-duplicate records, 16 studies met the inclusion criteria. Five achieved an overall “moderate” (none achieved “high”) quality of evidence and evaluated prostaglandin analogues (PGAs) – latanoprost, travoprost, and bimatoprost; timolol; “other beta-blockers;” carbonic anhydrase inhibitors (CAI) as a group or dorzolamide separately; and brimonidine. “Moderate quality” refers to efficacy and incidence of conjunctival hyperemia. Quality of evidence regarding other tolerability aspects was low. PGAs should be considered equivalent regarding efficacy, but latanoprost was relevantly better tolerated than the other two. Non-PGA compounds did not relevantly differ between each other in either efficacy or safety. Timolol and brimonidine were relevantly less effective than all PGAs. The same was true for CAI vs bimatoprost. Regarding tolerability, timolol was superior to all PGAs and brimonidine and CAI were superior to bimatoprost.ConclusionNo high quality evidence on relative efficacy and tolerability of the most commonly used mono-compound IOP-lowering drugs for POAG/OHT exists. Moderate quality evidence indicates latanoprost as a treatment with the most favorable trade-off between benefits and harms.

К Вопросу О Преимуществах Применения Бесконсервантной Формы Простагландинов F2-Альфа У Больных Первичной Открытоугольной Глаукомой

“…Это наиболее физиологический путь оттока камерной влаги, поскольку в нем не участвует уменьшение выработки камерной влаги. Эффективность и физиологичность гипотензивного действия -это первая причина для выбора синтетических простагландинов в качестве препаратов первого выбора в лечении глаукомы [6,7,19,21].…”

Cost-effectiveness of glaucoma management with monotherapy medications in Egypt

“…The higher the IOP, the greater the risk of optic nerve damage, visual loss, and blindness. [ 1 2 3 ] Early, pressure-lowering treatment is a dominant cost-effective treatment strategy over a strategy to start the same treatment approach later, after glaucoma has occurred for patients with ocular hypertension. [ 4 ]…”

A Randomized, Controlled Comparison of NCX 470 (0.021%, 0.042%, and 0.065%) and Latanoprost 0.005% in Patients With Open-angle Glaucoma or Ocular Hypertension: The Dolomites Study

“…According to the Early Manifest Glaucoma Trial (EMGT), every 1 mm Hg of IOP lowering further reduced the risk of glaucomatous progression 3. Topical prostaglandin analogues (PGAs) have become the mainstay of initial medical treatment due to their efficacy and safety in lowering IOP 4. Generic latanoprost is the most commonly prescribed PGA although clinical trials reported a greater reduction in IOP in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT) with bimatoprost 0.03% compared with either travoprost 0.004% or latanoprost 0.005% in some instances 5.…”