Meta-analysis of 24-Hour Intraocular Pressure Studies Evaluating the Efficacy of Glaucoma Medicines

Stewart, William C.; Konstas, Anastasios G. P.; Nelson, Lindsay A.; Kruft, Bonnie

doi:10.1016/j.ophtha.2007.10.004

Cited by 177 publications

(166 citation statements)

References 35 publications

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“…This probably reflects the respondents' assessment of drug efficacy and safety rather than affordability, since there was agreement that the cost of medical therapy is not affordable for most patients in Latin America (question 42). Prostaglandin analogs have demonstrated greater hypotensive efficacy compared with other classes of topical glaucoma therapies (22,23) and a low rate of systemic adverse effects, a fact with which the Latin American respondents to our survey also showed substantive agreement. The most common adverse event with prostaglandin analogs is conjunctival hyperemia, whereas this is less frequent with topical β-blockers (24) .…”

Section: Discussionsupporting

confidence: 65%

Level of agreement among Latin American glaucoma subspecialists on the diagnosis and treatment of glaucoma: results of an online survey

Grigera¹,

Mello²,

Barbosa³

et al. 2013

Arq. Bras. Oftalmol.

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70% of respondents. RESULTS: Fifty participants from 14 countries completed the questionnaire. For the medical treatment of glaucoma, nearly all respondents (98% or greater) confirmed that medical treatment as first-line therapy is preferred to surgery, prostaglandin analogs are the medication of first choice for primary open-angle glaucoma (POAG), longitudinal monitoring of efficacy should include intraocular pressure, structural and functional status, as well as if patients' quality of life is impaired by the high cost of medication. For the diagnosis of glaucoma section, all respondents confirmed that, after initial examination, gonioscopy should be repeated over time, standard automated perimetry is the most important functional examination for diagnosis and monitoring of primary open-angle glaucoma, central corneal thickness is important in assessment of glaucoma, and computerized imaging tests help in clinical evaluation of optic disc. CONCLUSIONS: This survey shows a high level of agreement on most aspects of glaucoma diagnosis and treatment among Latin American glaucoma experts. Areas of disagreement highlight the need for further evidence or education. These findings will be useful for guiding future efforts to optimize glaucoma practice by clinicians in Latin America.]]>

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Section: Discussionsupporting

confidence: 65%

Level of agreement among Latin American glaucoma subspecialists on the diagnosis and treatment of glaucoma: results of an online survey

Grigera¹,

Mello²,

Barbosa³

et al. 2013

Arq. Bras. Oftalmol.

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“…In the meta-analysis performed by Stewart et al, 1 however, the mean nighttime IOP reduction was statistically lower than the daytime IOP reduction for latanoprost, but not for travoprost. In the present long-term 24-hour study, although mean nocturnal IOP reduction with travoprost was somewhat lower than the mean daytime IOP reduction, there was no significant difference between nighttime and daytime efficacy.…”

Section: Discussionmentioning

confidence: 80%

“…Prostaglandin analogues have become a popular firstline therapy option for lowering IOP in POAG owing to their superior 24-hour efficacy, [1][2][3][4][5][6] convenient once-a-day administration, 5 and favorable systemic safety profile. 7 Travoprost is a synthetic prostaglandin F2a analogue that exerts its IOP-lowering effect through the prostaglandin FP receptors situated at the ciliary muscle 8 and the trabecular meshwork.…”

mentioning

confidence: 99%

Long-term 24-hour Intraocular Pressure Control With Travoprost Monotherapy in Patients With Primary Open-angle Glaucoma

Riva

Katsanos

Floriani

et al. 2014

Journal of Glaucoma

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Purpose: The aim of the study was to evaluate the long-term 24-hour intraocular pressure (IOP) efficacy of travoprost monotherapy in primary open-angle glaucoma patients.Patients and Methods: A total of 36 previously untreated primary open-angle glaucoma patients were enrolled in this 5-year study.Patients underwent an untreated 24-hour IOP evaluation. Subsequently all patients were assigned to topical therapy with travoprost 0.004% eye-drops preserved with benzalkonium chloride (Travatan, Alcon Laboratories Inc., Fort Worth, TX) administered once in the evening (8:00 PM) in both eyes. All patients were then scheduled for a 24-hour IOP assessment approximately 12 months after the baseline visit. This schedule of follow-up was maintained for the whole duration of the trial. The predetermined range of target IOP reduction selected in this cohort of patients ranged between 20% and 30%.Results: A total of 34 patients completed all phases of the investigation. The mean survival time was 57.3 ± 2.0 months and the cumulative survival rate was 0.82 ± 0.6 at 60 months. Travoprost reduced the mean 24-hour IOP from 23.4 ± 1.7 mm Hg at baseline to 16.8 ± 2.4 mm Hg (28.4%), 16.8 ± 2.5 mm Hg (28.1%), 16.8 ± 2.4 mm Hg (28.5%), 16.7 ± 2.5 mm Hg (28.6%), and 16.9 ± 2.4 mm Hg (27.8%), respectively at the end of the first, second, third, fourth, and fifth year follow-up. No drug-related serious adverse events were registered during the study.Conclusions: The present study demonstrated the long-term 24-hour efficacy of travoprost for the treatment of primary open-angle glaucoma.Key Words: open-angle glaucoma, prostaglandin analogue, circadian intraocular pressure, travoprost (J Glaucoma 2014;23:535-540) R eduction of intraocular pressure (IOP) is the only currently available, evidence-based management strategy in patients affected with primary open-angle glaucoma (POAG). Most POAG patients will require lifelong medical therapy to avoid visual loss. The decision to select medical therapy options relies primarily on the efficacy of the available medications in various therapeutic trials. Sadly, most published studies only evaluate the short-term, daytime efficacy of medical therapy.Prostaglandin analogues have become a popular firstline therapy option for lowering IOP in POAG owing to their superior 24-hour efficacy, 1-6 convenient once-a-day administration, 5 and favorable systemic safety profile. 7 Travoprost is a synthetic prostaglandin F2a analogue that exerts its IOP-lowering effect through the prostaglandin FP receptors situated at the ciliary muscle 8 and the trabecular meshwork. 9 Travoprost is increasingly becoming a popular first-line monotherapy option for POAG patients 10 as there is cumulative evidence suggesting good quality of shortterm 24-hour IOP control with low fluctuation, especially with evening administration. 11-13 However, although several controlled studies have demonstrated the daytime short-term efficacy of travoprost monotherapy, [14][15][16] little is currently known about its long-term efficacy.As POA...

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“…2007; Stewart et al. 2008), but these comparisons have been carried out between only a limited number of regimens because data from randomized controlled trials involve limited types of drugs. A previous network meta‐analysis compared the treatment effect of several PGAs, AAs, BBs and placebo (van der Valk et al.…”

Section: Introductionmentioning

confidence: 99%

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

Huang

Zhang

2017

Acta Ophthalmologica

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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.

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Meta-analysis of 24-Hour Intraocular Pressure Studies Evaluating the Efficacy of Glaucoma Medicines

Cited by 177 publications

References 35 publications

Level of agreement among Latin American glaucoma subspecialists on the diagnosis and treatment of glaucoma: results of an online survey

Level of agreement among Latin American glaucoma subspecialists on the diagnosis and treatment of glaucoma: results of an online survey

Long-term 24-hour Intraocular Pressure Control With Travoprost Monotherapy in Patients With Primary Open-angle Glaucoma

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

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