Meta-analysis of randomised controlled trials comparing latanoprost with brimonidine in the treatment of open-angle glaucoma, ocular hypertension or normal-tension glaucoma

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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“…2001; Fung et al. 2007; Cheng et al. 2009) and one previous network meta‐analysis (van der Valk et al.…”

Section: Discussionmentioning

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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“…19 When medical therapy has been chosen as initial treatment for open-angle glaucoma prostaglandins are generally considered first-line therapy. Most 20,21 but not all 22 metaanalyses have found prostaglandins to be more effective than beta blockers, carbonic anhydrase inhibitors, and alpha adrenergic agonists for the treatment of open-angle glaucoma. Beta blockers may be more appropriate as initial therapy for those patients who cannot afford a topical prostaglandin.…”

Section: Discussionmentioning

confidence: 99%

A comparative study on safety and efficacy of travoprost and brimonidine/timolol fixed combination in patients of primary open angle glaucoma

Mehani

Gupta

Yadav

et al. 2015

Int J Basic Clin Pharmacol

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INTRODUCTIONGlaucoma is the "silent thief of sight." It is the second leading cause of blindness globally, 1 accounts for 12.3% of total blindness. 2 The estimated number of people with vision loss from glaucoma range from 5.2 to 6.7 million. 3If left undiagnosed and untreated there is slow progressive degeneration of retinal ganglion cells and the optic nerve axons, leading to irreversible blindness.Prevalence of glaucoma varies between 1% and 4% in people over 40, and they increase with age. The incidence rate is estimated to be 0.1% per year. 4 Several randomized controlled trials have determined that reduction in IOP can delay glaucomatous nerve or field damage.5-7 Normal intraocular pressure ranges from 10 to 2 mmHg. Data from the Early Manifest Glaucoma Trial have shown that an additional 1 mmHg of IOP lowering reduces the risk of glaucoma progression by 10%.7 Lowering of IOP remains ABSTRACTBackground: The purpose of this study was to compare and evaluate the clinical efficacy of topically applied travoprost 0.004% eye drops versus brimonidine/timolol fixed combination eye drops in the management of primary open-angle glaucoma. Methods: In this prospective, randomized study, 65 patients received either travoprost eye drops once daily in the morning (n=33) or brimonidine/timolol fixed combination eye drops twice daily (n=32). Intra ocular pressure (IOP) was assessed at 2, 4, 8, and 12 weeks. The primary outcome measure was mean reduction in IOP. Results:The baseline mean IOP values were similar between two groups. Mean reduction of IOP in the right eye for brimonidine/timolol fixed combination group was 9±2.9 mmHg, whereas in the left eye it was 10.9±2.8 mmHg. In the travoprost group, the reduction in IOP of the right eye was 7.8±2.9 mmHg (p=0.0002) and 7.5±3.4 mmHg (p=0.0001) in the left eye. The mean reduction of IOP for the brimonidine/timolol group was 9.95 mmHg and for the travoprost group it was 7.6 mmHg (p<0.0001) in both the eyes. Conclusions:The fixed combination brimonidine/timolol twice daily demonstrated superior mean IOP lowering efficacy compared to travoprost 0.004% in patients with open-angle glaucoma.

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“…In contrast, head-to-head trials, 43,52,53,59,70,76,77,83,[150][151][152][153][154][155][156][157] only were analyzed for the second meta-analysis. 146 The pooled summary estimate significantly favored latanoprost (weighted mean difference (WMD) = 1.10, 95% CI 0.57 to 1.63) over brimonidine. A third meta-analysis 158 did not find a significant reduction in mean IOP when latanoprost was compared with brimonidine (WMD = −1.04; P = 0.30).…”

Section: Vs Brimonidinementioning

confidence: 99%

“…Two meta-analyses 145,146 comparing efficacy of latanoprost and brimonidine both favored latanoprost for IOP lowering. 145 In one meta-analysis, 145 the estimated absolute decrease in IOP from baseline for latanoprost and brimonidine was respectively −8.4 and −6.5 mmHg at 3 months (P = 0.004) and −8.0 and −6.2 mmHg at 6 months (P = 0.045).…”

Section: Vs Brimonidinementioning

confidence: 99%

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

Lee

McCluskey

2010

OPTH

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Prostaglandin analogs (PGA) are powerful topical ocular hypotensive agents available for the treatment of elevated intraocular pressure (IOP). Latanoprost 0.005% and travoprost 0.004% are prodrugs and analogs of prostaglandin F2α. Bimatoprost 0.03% is regarded as a prostamide, and debate continues as to whether it is a prodrug. The free acids of all 3 PGAs reduce IOP by enhancing uveoscleral and trabecular outflow via direct effects on ciliary muscle relaxation and remodeling of extracellular matrix. The vast majority of clinical trials demonstrate IOP-lowering superiority of latanoprost, bimatoprost and travoprost compared with timolol 0.5%, brimonidine 0.2%, or dorzolamide 2% monotherapy. Bimatoprost appears to be more efficacious in IOPlowering compared with latanoprost, with weighted mean difference in IOP reduction documented in one meta-analysis of 2.59% to 5.60% from 1-to 6-months study duration. PGAs reduce IOP further when used as adjunctive therapy. Fixed combinations of latanoprost, bimatoprost or travoprost formulated with timolol 0.5% and administered once daily are superior to monotherapy of its constituent parts. PGA have near absence of systemic side effects, although do have other commonly encountered ocular adverse effects. The adverse effects of PGA, and also those found more frequently with bimatoprost use include ocular hyperemia, eyelash growth, and peri-ocular pigmentary changes. Iris pigmentary change is unique to PGA treatment. Once daily administration and near absence of systemic side effects enhances tolerance and compliance. PGAs are often prescribed as first-line treatment for ocular hypertension and open-angle glaucoma.

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Meta-analysis of randomised controlled trials comparing latanoprost with brimonidine in the treatment of open-angle glaucoma, ocular hypertension or normal-tension glaucoma

Abstract: Latanoprost is more effective than brimonidine as monotherapy in lowering IOP. Brimonidine is associated with a higher rate of fatigue.

Cited by 36 publications

References 39 publications

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

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

A comparative study on safety and efficacy of travoprost and brimonidine/timolol fixed combination in patients of primary open angle glaucoma

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

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