Meta-Analysis of Prostaglandin Analogues for Treating IOP in Patients with POAG or OHT
Introduction
Currently, lowering intraocular pressure (IOP) is the only approved approach for preventing glaucoma in patients with ocular hypertension (OHT) and for preventing or delaying glaucomatous progression in patients with primary open angle glaucoma (POAG). Prostaglandin analogues (PGs) are the most potent ocular hypotensive medications used for treating POAG and OHT. Currently, there is no latest data on comparison of various PGs for IOP control.
Aim
To evaluate and compare the efficacy and safety of 3 PGs (0.005% latanoprost, 0.004% travoprost, and 0.03% bimatoprost) for the treatment of POAG or OHT
Study Selection Criteria
- The included studies were randomized controlled trials (RCTs) related to use of one of the three PGs (latanoprost, travoprost, bimatoprost) for treating IOP in adult patients with POAG or OHT
Methods
Study Design
- Systematic review and meta-analysis
Results
- Seventeen studies providing data for 2433 patients and having follow-up of 1∼12 months’ were included in the systematic review and meta-analysis.
- Latanoprost and travoprost had no significant difference in reducing IOP at 1, 3 and 6 months post-treatment.
- As per fixed model analysis, bimatoprost had greater efficacy vs. travoprost in lowering IOP in the third month. Similar trend was evident in first and sixth month of treatment as well (Table 1).
- Bimatoprost also had a better efficacy in reducing IOP as compared with latanoprost, in the first, third and sixth month (Table 1).
|
Period |
Weighted mean difference [WMD (95% CI), P value] |
I2 heterogeneity (p value) |
|
Bimatoprost vs. Travoprost | ||
|
First month |
-0.64 mmHg (-1.64 to 0.37, P=0.21) |
43%, heterogeneity P=0.13 |
|
Third month |
-0.93 mmHg (-1.25 to -0.60, P<.00001) |
1%, heterogeneity P=0.43 |
|
Sixth month |
-0.71 mmHg (-1.65 to 0.23, P=0.14) |
49%, heterogeneity P=0.08 |
|
Bimatoprost vs. Latanoprost | ||
|
First month |
-0.11 mmHg (-0.97 to 0.76, P=0.81) |
0%, heterogeneity, P=0.1 |
|
Third month |
-0.75 mmHg (-1.05 to -0.45, P<0.00001) |
61%, heterogeneity P=0.009 |
|
Sixth month |
-0.82 mmHg (-1.55 to -0.09, P=0.03) |
35%, heterogeneity P=0.19 |
- As compared with latanoprost, travoprost was associated with an increased risk of adverse events including conjunctival hyperemia (OR=0.50, 95% CI 0.40–0.63, P<.00001, I2=0%, heterogeneity P=0.53).
- With respect to latanoprost and bimatoprost, all the adverse events except for discomfort, differed significantly between two medications (OR=0.63, 95% CI 0.35–1.13, P=.12, I2=0%, heterogeneity P=0.96).
- Bimatoprost showed lower ocular tolerability with higher incidence of conjunctival hyperemia when compared with travoprost (OR=0.64, 95% CI 0.46–0.88, P=.007, I2=0%, heterogeneity P=0.89), but the incidence of discomfort and growth of lashes was similar with both the medications.
Conclusions
- 0.03% bimatoprost was more effective for controlling IOP when compared with 0.005% latanoprost following long-term use (3 and 6 month post-treatment) and was more effective compared to 0.004% travoprost after being used for a certain period of time (3 months post-treatment).
- Latanoprost and travoprost had similar efficacy in lowering IOP; nevertheless, latanoprost had a better tolerability profile in patients with POAG or OHT.
- Based on these findings, the use of bimatoprost is recommended for patients who can tolerate the adverse events.
- Considering that, every patient has a different response to PGs; ophthalmologists should consider all aspects for every patient. Personalized IOP treatment may soon be a trend in near future.
Medicine 2019; 98 (30): e16597.
