Meta-analysis of randomised controlled trials comparing latanoprost with timolol in the treatment of patients with open angle glaucoma or ocular hypertension
W Y Zhanga, A Li Wan Poa, H S Duab, A Azuara-Blancoc
a Centre for
Evidence-Based Pharmacotherapy, School of Life and Health Sciences,
Aston University, Aston Triangle, Birmingham B4 7ET, UK, b Division of
Ophthalmology, Clinical Laboratory Sciences, Queens Medical Centre,
Nottingham NG7 2UH, UK, c The
Eye Clinic, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK
Correspondence to: Dr W Y Zhang w.y.zhang{at}aston.ac.uk
Accepted for publication 7 February 2001
AIM
To evaluate the
comparative efficacy and tolerance of latanoprost versus timolol
through a meta-analysis of randomised controlled trials (RCTs).
METHODSSystematic
retrieval of RCTs of latanoprost versus timolol to allow pooling of
results from head to head comparison studies. Quality of trials was
assessed based on randomisation, masking, and withdrawal. Sensitivity
analyses were used to estimate the effects of quality of study on
outcomes. The data sources were Medline, Embase, Scientific Citation
Index, Merck Glaucoma, and Pharmacia and Upjohn ophthalmology
databases. There were 1256 patients with open angle glaucoma or ocular
hypertension reported in 11 trials of latanoprost versus timolol. The
main outcome measures were (i) percentage intraocular pressure (IOP)
reduction for efficacy; (ii) relative risk, risk difference, and number
needed to harm for side effects such as hyperaemia, conjunctivitis,
increased pigmentation, hypotension, and bradycardia expressed as
dichotomous outcomes; and (iii) reduction in systemic blood pressure
and heart rate as side effects.
RESULTSBoth 0.005%
latanoprost once daily and 0.5% timolol twice daily reduced IOP. The
percentage reductions in IOP from baseline (mean (SE)) produced by
latanoprost and timolol were 30.2 (2.3) and 26.9 (3.4) at 3 months. The
difference in IOP reduction between the two treatments were 5.0 (95%
confidence intervals 2.8, 7.3). However, latanoprost caused iris
pigmentation in more patients than timolol (relative risk = 8.01, 95%
confidence intervals 1.87, 34.30). The 2 year risk with latanoprost
reached 18% (51/277). Hyperaemia was also more often observed with
latanoprost (relative risk =2.20, 95% confidence intervals 1.33, 3.64). Timolol caused a significant reduction in heart rate of 4 beats/minute (95% confidence interval 2, 6).
CONCLUSIONThis
meta-analysis suggests that latanoprost is more effective than timolol
in lowering IOP. However, it often causes iris pigmentation. While
current evidence suggests that this pigmentation is benign, careful
lifetime evaluation of patients is still justified.
© 2001 by British Journal of Ophthalmology
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