Mixed treatment comparison and meta-regression of the efficacy and safety of prostaglandin analogues and comparators for primary open-angle glaucoma and ocular hypertension

Abstract

This analysis suggests that latanoprost and bimatoprost produce a statistically significant reduction in IOP compared with timolol, but are associated with a higher risk of hyperaemia. Out of all the prostaglandins, latanoprost may achieve a good balance between tolerability and IOP efficacy. As with all forms of meta-analysis, the results are based on the assumption that the studies and intervention groupings are sufficiently similar to be compared.

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

“…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.…”

Long-term Medical Management of Primary Open-Angle Glaucoma and Ocular Hypertension in the UK

“…As this was a complex and lengthy exercise the write up of the methodology and results of the SR and the meta-analyses are subject to a separate publication. 12,13 An overview of the SR search results and the data used in the model are provided below.…”

“…Other IOP targets were analyzed using this method but the results are not presented in this paper. 13 The data used to model the instantaneous probability of switching treatment at time 3 months owing to a lack of tolerance (Trigger 1) or lack of IOP control (Trigger 2) are summarized in Table 5.…”

“…Two separate analyses were conducted using clinical trial data (mean absolute IOP on treatment) obtained from the SR. First to assess the relative efficacy of topical therapies, we conducted an MTC of absolute IOP after 3 months of treatment 13 (Table 4 for summary results). Note that a total of 18 studies (2943 patients) were included in this MTC, 20,23,28,37,40,51,55,60,73,78,89,[91][92][93][94]98,107,109 as these were the only studies included in the SR extraction that reported sufficient data on mean and standard deviation in IOP.…”

“…Before conducting the modeling exercise described in this paper, a large and comprehensive systematic review (SR) of glaucoma clinical trials was carried out to assess the current clinical evidence on topical hypotensives. 12,13 Despite a large number of clinical trials published for topical hypotensives (B500 randomized controlled trials published up to 2007), the relative efficacy of treatments head-to-head is not immediately apparent. Furthermore, it is not clear how a difference in IOP-lowering between treatments translates to a difference in quality of vision and glaucoma progression over a patient's lifetime.…”