IngentaConnect A meta-analysis of topical prostaglandin analogues intra-ocular p...

Abstract:

Objective: To compare the efficacy of latanoprost, bimatoprost and travoprost for lowering IOP in patients with glaucoma.

Research design and methods: In order to carry out this meta-analysis, randomized trials (2001-2004) were identified on Medline and EMBASE using the following key words: glaucoma, ocular hypertension (OHT), randomization, trial, latanoprost, bimatoprost and travoprost. The studies had to compare at least two prostaglandin analogues as mono-therapy. Cross-over experimental designs were excluded. The main outcome measure was IOP at final visit. Statistical analyses included random effects, pooled estimates of treatment effects, tests for publication bias, and random-effects models to obtain adjusted treatment effects on final IOP after lowering for baseline IOP, and duration of follow-up. Random effects Poisson regression models were used to estimate the adjusted effects of treatments on response rates (IOP < 18 mmHg).

Results: Nine studies were used in the analysis. Patient mean age varied from 56.7 to 68.8 years and baseline IOP ranged from 22.3 to 26.5 mmHg. Three hundred and seventy-eight patients were treated with bimatoprost, 385 with travoprost and 555 with latanoprost. Patients treated with travoprost and bimatoprost had lower IOP levels at the end of follow-up (−0.98 mmHg [95% CI: −2.08; 0.13; p = 0.08] and −1.04 mmHg [95% CI: −2.11;0.04; p = 0.06], respectively) than those treated with latanoprost. The combined effect of newer prostaglandin analogues (bimatoprost/travoprost) was an adjusted decrease of 1.00 mmHg [95% CI: −1.91;−0.10], p = 0.03], or a 17% higher adjusted response rate (Incidence Rate Ratio 1.17, 95% CI, 1.00-1.35, p = 0.04), compared to latanoprost.

Conclusion: Travoprost and bimatoprost may have greater efficacy in lowering IOP for patients with OHT or glaucoma.

Keywords: EFFICACY; GLAUCOMA; INTRA-OCULAR PRESSURE; META ANALYSIS; PROSTAGLANDIN ANALOGUES

Document Type: Research article

DOI: 10.1185/030079907X178720

Affiliations: 1: Hôpital Edouard Herriot, Service d'ophtalmologie, 5, Place Arsonval, F-69003 Lyon, France 2: Cemka Eval, 43 boulevard du Maréchal Joffre, F-92340 Bourg la Reine, France 3: AlconFrance, 4 rue Henri Sainte-Claire Deville, F-92653 Rueil Malmaison, France 4: AlconFrance, 4 rue Henri Sainte-Claire Deville, F-92653 Rueil Malmaison, France; Conservatoire National des Arts et Métiers, 292, rue Saint-Martin, 75003 Paris, France

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A meta-analysis of topical prostaglandin analogues intra-ocular pressure lowering in glaucoma therapy