title: Efficacy and safety of prostaglandin analogues in patients with predominantly primary open-angle glaucoma or ocular hypertension: a meta-analysis.
abstract: BACKGROUND
  First-line therapy for primary open-angle glaucoma and ocular hypertension generally involves prostaglandin analogue therapy. The relative efficacy of differing prostaglandin therapy is disputed.
  
  
  METHODS
  A meta-analysis was conducted of head-to-head randomized trials of prostaglandin therapies. We included randomized trials assessing head-to-head evaluations of prostaglandin analogues travoprost, latanoprost and bimatoprost in patients with predominantly primary open-angle glaucoma or ocular hypertension. Findings were interpreted in light of equivalence margins.
  
  
  RESULTS
  Our search identified 16 eligible trials, of which 15 were included in the meta-analysis. Trials were, in general, poorly reported. We pooled 9 trials assessing IOP-lowering effects of travoprost vs latanoprost (total n = 1098, weighted mean difference [WMD], -0.24 mmHg, 95% CI, -0.87 to 0.38, P = 0.45, I2 = 56%, 95% CI, 0 to 0.77, heterogeneity P = 0.01). Eight trials assessed travoprost vs bimatoprost (total n = 714, WMD, 0.88 mmHg, 95% CI, 0.13 to 1.63, P = 0.02, I2 = 56%, 95% CI, 0% to 78%, heterogeneity P = 0.02). And 8 trials assessed latanoprost vs bimatoprost (total n = 943, WMD, 0.73 mmHg, 95% CI, 0.10 to 1.37, P = 0.02, I2 = 47%, 95% CI, 0% to 74%, heterogeneity P = 0.06). Travoprost was associated with greater incidence of conjunctival hyperemia than latanoprost (RR 5.71, 95% CI, 1.81 to 18.02, P </= 0.001, I2 = 97%, 95% CI, 95 to 98, P </= 0.001). Five trials assessing latanoprost and bimatoprost revealed an elevated risk of conjunctival hyperemia with bimatoprost (RR 1.59, 95% CI, 1.02 to 2.48, P = 0.04, I2 = 76%, 95% CI, 16 to 88, P = 0.002).
  
  
  CONCLUSIONS
  Randomized head-to-head evaluations of prostaglandin therapy demonstrate similar efficacy effects, but differing hyperemia effects.
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada.
authors.forename: Oghenowede
authors.initials: O
authors.lastname: Eyawo
authors.forename: Jean
authors.initials: J
authors.lastname: Nachega
authors.forename: Pierre
authors.initials: P
authors.lastname: Lefebvre
authors.forename: David
authors.initials: D
authors.lastname: Meyer
authors.forename: Beth
authors.initials: B
authors.lastname: Rachlis
authors.forename: Chia-Wen
authors.initials: CW
authors.lastname: Lee
authors.forename: Steven
authors.initials: S
authors.lastname: Kelly
authors.forename: Edward
authors.initials: E
authors.lastname: Mills
references.citation: Control Clin Trials. 1986 Sep;7(3):177-88
references.pmid: 3802833
references.citation: Clin Exp Ophthalmol. 2006 Nov;34(8):755-64
references.pmid: 17073898
references.citation: Am J Respir Crit Care Med. 2001 Feb;163(2):490-3
references.pmid: 11179128
references.citation: Lancet. 1999 Nov 20;354(9192):1803-10
references.pmid: 10577657
references.citation: JAMA. 1995 Feb 1;273(5):408-12
references.pmid: 7823387
references.citation: Br J Ophthalmol. 2006 Nov;90(11):1370-3
references.pmid: 16825272
references.citation: Acta Ophthalmol Scand. 2007 Dec;85(8):838-43
references.pmid: 17680841
references.citation: J Glaucoma. 2005 Jun;14(3):239-42
references.pmid: 15870608
references.citation: Curr Ther Res Clin Exp. 2003 Jul;64(7):389-400
references.pmid: 24944390
references.citation: JAMA. 2001 Apr 18;285(15):2000-3
references.pmid: 11308438
references.citation: JAMA. 2006 Mar 8;295(10):1152-60
references.pmid: 16522836
references.citation: Br J Ophthalmol. 2008 Jan;92(1):7-12
references.pmid: 18156371
references.citation: Stat Med. 2002 Jun 15;21(11):1539-58
references.pmid: 12111919
references.citation: Curr Med Res Opin. 2006 Nov;22(11):2175-80
references.pmid: 17076978
references.citation: J Ocul Pharmacol Ther. 2003 Feb;19(1):23-35
references.pmid: 12648301
references.citation: Surv Ophthalmol. 2004 Mar;49 Suppl 1:S12-8
references.pmid: 15016557
references.citation: JAMA. 1999 Oct 13;282(14):1371-7
references.pmid: 10527185
references.citation: Adv Ther. 2006 May-Jun;23(3):385-94
references.pmid: 16912020
references.citation: Br J Ophthalmol. 2003 Jan;87(1):57-62
references.pmid: 12488264
references.citation: Eye (Lond). 2007 Apr;21(4):453-8
references.pmid: 16543930
references.citation: Am J Ophthalmol. 2001 Oct;132(4):472-84
references.pmid: 11589866
references.citation: Adv Ther. 2001 May-Jun;18(3):110-21
references.pmid: 11571823
references.citation: Trials. 2008 Dec 03;9:69
references.pmid: 19055743
references.citation: BMJ. 2005 Jul 16;331(7509):134
references.pmid: 15994659
references.citation: Am J Ophthalmol. 2003 Jan;135(1):55-63
references.pmid: 12504698
references.citation: Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003167
references.pmid: 17943780
references.citation: Ophthalmology. 2008 Aug;115(8):1320-7, 1327.e1-3
references.pmid: 18321582
references.citation: Arch Ophthalmol. 2005 Feb;123(2):186-92
references.pmid: 15710814
references.citation: JAMA. 2006 Mar 8;295(10):1147-51
references.pmid: 16522835
references.citation: Expert Opin Drug Saf. 2007 Jan;6(1):45-52
references.pmid: 17181451
references.citation: Adv Ther. 2003 Mar-Apr;20(2):121-8
references.pmid: 12836812
references.citation: Ophthalmology. 1994 Mar;101(3):454-60
references.pmid: 7907416
references.citation: Ophthalmologica. 2004 Sep-Oct;218(5):312-7
references.pmid: 15334011
references.citation: Am J Ophthalmol. 2003 May;135(5):688-703
references.pmid: 12719078
references.citation: Arch Ophthalmol. 2002 Jun;120(6):714-20; discussion 829-30
references.pmid: 12049575
references.citation: Eur J Ophthalmol. 2007 Mar-Apr;17(2):183-90
references.pmid: 17415690
references.citation: Br J Ophthalmol. 2007 Jan;91(1):62-8
references.pmid: 16956912
references.citation: Eur J Ophthalmol. 2006 Jan-Feb;16(1):73-80
references.pmid: 16496249
references.citation: Curr Med Res Opin. 2007 Mar;23(3):601-8
references.pmid: 17355741
references.citation: Am J Public Health Nations Health. 1966 Oct;56(10):1745-50
references.pmid: 5951494
references.citation: Eye (Lond). 2009 May;23(5):1098-110
references.pmid: 18617908
references.citation: Arch Ophthalmol. 2002 Jun;120(6):701-13; discussion 829-30
references.pmid: 12049574
references.citation: Ophthalmology. 2005 Aug;112(8):1337-42
references.pmid: 16024084
references.citation: Clin Ther. 2008 Apr;30(4):622-32
references.pmid: 18498911
references.citation: Ophthalmology. 2005 Jul;112(7):1177-85
references.pmid: 15921747
references.citation: Cochrane Database Syst Rev. 2005 Apr 18;(2):CD004399
references.pmid: 15846712