Meta-analysis of 24-hour intraocular pressure studies evaluating the efficacy of glaucoma medicines.
OBJECTIVE
To evaluate efficacy and safety data of currently available ocular hypotensive medicines derived from 24-hour studies, of similar design, in patients with primary open-angle glaucoma (POAG), exfoliative glaucoma, or ocular hypertension (OH).


METHODS
Meta-analysis of published articles evaluating patients with POAG, exfoliative glaucoma, or OH.


METHODS
We included articles that were randomized, prospective, single- or double-masked, comparative studies of ocular hypotensive therapies over 24 hours. Each article selected contained an untreated baseline, >or=4-week treatment period, >/=20 patients per treatment arm, and >or=6 time points not spaced >5 hours apart and used Goldmann applanation or Tonopen tonometry (supine measurements) to measure intraocular pressure (IOP).


METHODS
Twenty-four-hour IOP efficacy.


RESULTS
This analysis included 864 separate 24-hour treatment curves from 386 patients in 28 treatment arms from 11 studies. A statistical difference in the mean diurnal pressure decrease existed between monotherapy treatments for POAG/OH patients, with bimatoprost (29%) and travoprost (27%) showing the greatest 24-hour reduction (P = 0.026). Timolol 0.5% was less effective than latanoprost (24% vs. 19% reduction) but decreased the pressure at each night time point (P = 0.0003). Dorzolamide showed a 19% 24-hour pressure reduction and brimonidine 0.2% a 14% one. In exfoliative glaucoma patients, latanoprost and travoprost showed higher baseline and treatment pressures, although the pressure reductions (29% and 31%, respectively) were greater generally than observed with POAG/OH. An evening-dosed latanoprost/timolol fixed combination reduced the pressure 33%, and the dorzolamide/timolol fixed combination (DTFC), 26%. However, the power to detect a difference for this specific comparison was probably low, due to the limited number of patients (n = 20) in the DTFC group. A statistical difference between evening-dosed (24%) and morning-dosed (18%) latanoprost (P<0.0001) was noted, but not between evening (27%) and morning (26%) travoprost (P = 0.074). The mean reduction of night time points was statistically lower than day time points for latanoprost (P = 0.031), timolol (P = 0.032), and brimonidine (P = 0.050), but not for dorzolamide. Dorzolamide (P = 0.60), travoprost (P = 0.064), and bimatoprost (P = 0.057) did not demonstrate nighttime pressures lower than daytime ones. The mean reduction of night time points was statistically lower than that of day time points for latanoprost (P = 0.031), timolol (P = 0.032), and brimonidine (P = 0.050), but not for dorzolamide (P = 0.60), bimatoprost (P = 0.057), travoprost (P = 0.064).


CONCLUSIONS
Similar relative efficacies generally exist in various classes of ocular hypotensive agents during night and day hours.
Stewart
William C
WC
PRN Pharmaceutical Research Network, LLC, Dallas, Texas, USA. info@prnorb.com
Konstas
Anastasios G P
AG
Nelson
Lindsay A
LA
Kruft
Bonnie
B
D000577:Amides / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D000069580:Bimatoprost; D002940:Circadian Rhythm / Q000187:drug effects* / Q000502:physiology; D003008:Cloprostenol / Q000008:administration & dosage / Q000031:analogs & derivatives; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D017889:Exfoliation Syndrome / Q000188:drug therapy / Q000503:physiopathology; D005902:Glaucoma, Open-Angle / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects* / Q000502:physiology; D000077338:Latanoprost; D009798:Ocular Hypertension / Q000188:drug therapy / Q000503:physiopathology; D009883:Ophthalmic Solutions / Q000008:administration & dosage; D011461:Prostaglandins F, Synthetic / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D016037:Single-Blind Method; D013449:Sulfonamides / Q000008:administration & dosage; D013876:Thiophenes / Q000008:administration & dosage; D013999:Timolol / Q000008:administration & dosage; D014065:Tonometry, Ocular; D000069557:Travoprost; D016896:Treatment Outcome
D000577:Amides; D000959:Antihypertensive Agents; D004338:Drug Combinations; D009883:Ophthalmic Solutions; D011461:Prostaglandins F, Synthetic; D013449:Sulfonamides; D013876:Thiophenes; D003008:Cloprostenol; D000077338:Latanoprost; D013999:Timolol; C062765:dorzolamide; D000069580:Bimatoprost; D000069557:Travoprost