Elsevier

Ophthalmology

Volume 112, Issue 7, July 2005, Pages 1177-1185
Ophthalmology

Original Article
Intraocular Pressure–Lowering Effects of All Commonly Used Glaucoma Drugs: A Meta-analysis of Randomized Clinical Trials

Preliminary results presented in part as a poster at: International Congress on Eye Research, September, 2004; Sydney, Australia.
https://doi.org/10.1016/j.ophtha.2005.01.042Get rights and content

Objective

To estimate the intraocular pressure (IOP) reduction achieved by the most frequently prescribed glaucoma drugs and a placebo in a meta-analysis of randomized clinical trials.

Design

Meta-analysis of randomized clinical trials.

Participants

Twenty-seven articles reporting on 28 randomized clinical trials. These articles reported 6953 participants for the trough and 6841 for the peak.

Methods

Articles published up to December 2003 were identified in the following data sources: Medline, Embase, and the Cochrane Controlled Trials Register, and references from relevant articles. Over 85% of the patients had to be diagnosed with primary open-angle glaucoma (POAG) or ocular hypertension (OH), and articles had to be written in English, German, French, or Dutch. Quality of trials was assessed by a Delphi list with additions. The pooled 1-month IOP-lowering effect from baseline at peak and trough was calculated by performing meta-analysis using the random effects model.

Main Outcome Measures

Absolute and relative change in IOP from baseline, for peak and trough moments.

Results

Relative IOP reductions from baseline [mean (95% confidence interval)] were −23% (−25% to −22%) for a peak and −20% (−23% to −17%) for a trough for 0.5% betaxolol; peak, −27% (−29% to −25%), and trough, −26% (−28% to −25%), for 0.5% timolol; peak, −22% (−24% to −20%), and trough, −17% (−19% to −15%), for 2.0% dorzolamide; peak, −17% (−19% to −15%), and trough, −17% (−19% to −15%) for 1.0% brinzolamide; peak, −25% (−28% to −22%), and trough, −18% (−21% to −14%) for 0.2% brimonidine; peak, −31% (−33% to −29%), and trough, −28% (−30% to −26%) for 0.005% latanoprost; peak, −31% (−32% to −29%), and trough, −29% (−32% to −25%) for 0.004% travoprost; peak, −33% (−35% to −31%), and trough, −28% (−29% to −27%) for 0.03% bimatoprost; and peak, −5% (−9% to −1%), and trough, −5% (−10% to −0%) for the placebo. The difference in absolute IOP reduction from baseline between timolol and prostaglandin analogs or prostamide varied from −0.4 to 0.1 mmHg at trough and from 1.0 to 1.5 mmHg at peak. Quality scores of included studies were generally high, a mean of 14.2 on a scale from 0 to 20 (interquartile range, 13–16).

Conclusion

This meta-analysis suggests that bimatoprost, travoprost, latanoprost, and timolol are the most effective intraocular pressure-reducing agents in POAG and OH patients.

Section snippets

Materials and Methods

Articles were identified through a computerized search in Medline, Embase, and the Cochrane Controlled Trials Register. The search strategy, as advised by the Cochrane Collaboration, was used to identify randomized clinical trials.5, 6, 7 The keywords for medication were betaxolol, timolol, dorzolamide, brinzolamide, brimonidine, latanoprost, travoprost, and bimatoprost and their commercial names. The keywords for the disease were ocul* and hypert*, explode Ocular-hypertension/all subheadings,

Study Eligibility and Quality

The flow of the randomized clinical trials included in our analysis is shown in Figure 1. The characteristics of the eligible studies are summarized in Table 3. In general, the quality of included studies was high (Table 3). The mean total quality score for all studies is 14.2, on a scale from 0 to 20 (interquartile range, 13–16). Twenty-six articles were included, which reported on 27 trials; 56 arms were reporting peak measurements; and 52 arms were reporting trough measurements. We included

Discussion

Our results confirm that the 8 drugs evaluated in this meta-analysis lower IOP more effectively than a placebo. The highest reduction in IOP at peak was achieved by bimatoprost (33%), followed by latanoprost, travoprost, timolol, brimonidine, betaxolol, dorzolamide, brinzolamide (17%), and a placebo (5%). At trough, the order is travoprost (31%), bimatoprost, latanoprost, timolol, betaxolol, brimonidine, brinzolamide, dorzolamide (17%), and a placebo (5%). However, the differences between

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Manuscript no. 2004-170.

Financial support: Dutch Health Care Insurance Council, Diemen, The Netherlands.

No author has any commercial (proprietary or financial) interest in any drug mentioned in the article.

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