Efficacy and tolerability of latanoprost compared to dorzolamide combined with timolol in the treatment of patients with elevated intraocular pressure: a meta-analysis of randomized, controlled trials.
OBJECTIVE
The aim of this study was to evaluate the efficacy and tolerability of latanoprost, compared with the combination of dorzolamide and timolol, in the treatment of patients with elevated intraocular pressure (IOP).


METHODS
Pertinent randomized, controlled trials were identified through systematic searches of the Cochrane Library, PubMed, EMBASE, Chinese Biomedicine Database, and internet searches of meeting abstracts and the manufacturers' databases. The main efficacy measures were the IOP reduction (IOPR), including diurnal mean IOPR, and 10:00 IOPR. The main tolerability measure was withdrawal due to adverse events and individual adverse events.


RESULTS
Fourteen (14) studies involving 2149 patients were included in the meta-analysis. Latanoprost was significantly more effective in lowering diurnal mean IOP than combined dorzolamide and timolol in patients with IOP insufficiently controlled by timolol alone, with a weighted mean difference (WMD) for the diurnal mean IOPR% of 3.12 (95% confidence interval, 0.47-5.78) at 3 months, and latanoprost was as effective as the combination of dorzolamide and timolol in patients without baseline timolol treatment. The combination of dorzolamide and timolol was associated with numerically greater reductions in 10:00 IOP, compared with latanoprost in patients with or without timolol treatment at baseline: only the result in patients with baseline timolol treatment at 1 month was statistically significant (WMD -4.14: range, -5.78 to -2.50). The combination of dorzolamide and timolol was less tolerated than latanoprost, with pooled relative risk for withdrawals due to adverse events being 0.34 (range, 0.13-0.84).


CONCLUSIONS
Latanoprost was associated with significantly greater efficacy in lowering diurnal mean IOP than combined dorzolamide and timolol in patients with IOP insufficiently controlled by timolol alone, and latanoprost was as effective as combined dorzolamide and timolol in patients without baseline timolol treatment. The combination of dorzolamide and timolol was less tolerated than latanoprost.
Cheng
Jin-Wei
JW
Department of Ophthalmology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China.
Xi
Gui-Lin
GL
Wei
Rui-Li
RL
Cai
Ji-Ping
JP
Li
You
Y
D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004338:Drug Combinations; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D000077338:Latanoprost; D009798:Ocular Hypertension / Q000188:drug therapy*; D009883:Ophthalmic Solutions; D011461:Prostaglandins F, Synthetic / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D013449:Sulfonamides / Q000009:adverse effects / Q000627:therapeutic use*; D013876:Thiophenes / Q000009:adverse effects / Q000627:therapeutic use*; D013999:Timolol / Q000009:adverse effects / Q000627:therapeutic use*
D000959:Antihypertensive Agents; D004338:Drug Combinations; D009883:Ophthalmic Solutions; D011461:Prostaglandins F, Synthetic; D013449:Sulfonamides; D013876:Thiophenes; D000077338:Latanoprost; D013999:Timolol; C062765:dorzolamide