A meta-analysis of topical prostaglandin analogues intra-ocular pressure lowering in glaucoma therapy.
OBJECTIVE
To compare the efficacy of latanoprost, bimatoprost and travoprost for lowering IOP in patients with glaucoma.


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.


CONCLUSIONS
Travoprost and bimatoprost may have greater efficacy in lowering IOP for patients with OHT or glaucoma.
Denis
Ph
P
Hôpital Edouard Herriot, Service d'ophtalmologie, 5, Place Arsonval, F-69003 Lyon, France.
Lafuma
A
A
Khoshnood
B
B
Mimaud
V
V
Berdeaux
G
G
D000287:Administration, Topical; D000368:Aged; D000577:Amides / Q000008:administration & dosage; D000069580:Bimatoprost; D003008:Cloprostenol / Q000008:administration & dosage / Q000031:analogs & derivatives; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D000077338:Latanoprost; D008055:Lipids / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000008:administration & dosage; D011336:Probability; D011461:Prostaglandins F, Synthetic / Q000008:administration & dosage; D011465:Prostaglandins, Synthetic / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D014065:Tonometry, Ocular; D000069557:Travoprost; D016896:Treatment Outcome
D000577:Amides; D008055:Lipids; D009883:Ophthalmic Solutions; D011461:Prostaglandins F, Synthetic; D011465:Prostaglandins, Synthetic; D003008:Cloprostenol; D000077338:Latanoprost; D000069580:Bimatoprost; D000069557:Travoprost