Efficacy and safety of prostaglandin analogues in patients with predominantly primary open-angle glaucoma or ocular hypertension: a meta-analysis.
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.
Eyawo
Oghenowede
O
Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada.
Nachega
Jean
J
Lefebvre
Pierre
P
Meyer
David
D
Rachlis
Beth
B
Lee
Chia-Wen
CW
Kelly
Steven
S
Mills
Edward
E
Control Clin Trials. 1986 Sep;7(3):177-88
3802833
Clin Exp Ophthalmol. 2006 Nov;34(8):755-64
17073898
Am J Respir Crit Care Med. 2001 Feb;163(2):490-3
11179128
Lancet. 1999 Nov 20;354(9192):1803-10
10577657
JAMA. 1995 Feb 1;273(5):408-12
7823387
Br J Ophthalmol. 2006 Nov;90(11):1370-3
16825272
Acta Ophthalmol Scand. 2007 Dec;85(8):838-43
17680841
J Glaucoma. 2005 Jun;14(3):239-42
15870608
Curr Ther Res Clin Exp. 2003 Jul;64(7):389-400
24944390
JAMA. 2001 Apr 18;285(15):2000-3
11308438
JAMA. 2006 Mar 8;295(10):1152-60
16522836
Br J Ophthalmol. 2008 Jan;92(1):7-12
18156371
Stat Med. 2002 Jun 15;21(11):1539-58
12111919
Curr Med Res Opin. 2006 Nov;22(11):2175-80
17076978
J Ocul Pharmacol Ther. 2003 Feb;19(1):23-35
12648301
Surv Ophthalmol. 2004 Mar;49 Suppl 1:S12-8
15016557
JAMA. 1999 Oct 13;282(14):1371-7
10527185
Adv Ther. 2006 May-Jun;23(3):385-94
16912020
Br J Ophthalmol. 2003 Jan;87(1):57-62
12488264
Eye (Lond). 2007 Apr;21(4):453-8
16543930
Am J Ophthalmol. 2001 Oct;132(4):472-84
11589866
Adv Ther. 2001 May-Jun;18(3):110-21
11571823
Trials. 2008 Dec 03;9:69
19055743
BMJ. 2005 Jul 16;331(7509):134
15994659
Am J Ophthalmol. 2003 Jan;135(1):55-63
12504698
Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003167
17943780
Ophthalmology. 2008 Aug;115(8):1320-7, 1327.e1-3
18321582
Arch Ophthalmol. 2005 Feb;123(2):186-92
15710814
JAMA. 2006 Mar 8;295(10):1147-51
16522835
Expert Opin Drug Saf. 2007 Jan;6(1):45-52
17181451
Adv Ther. 2003 Mar-Apr;20(2):121-8
12836812
Ophthalmology. 1994 Mar;101(3):454-60
7907416
Ophthalmologica. 2004 Sep-Oct;218(5):312-7
15334011
Am J Ophthalmol. 2003 May;135(5):688-703
12719078
Arch Ophthalmol. 2002 Jun;120(6):714-20; discussion 829-30
12049575
Eur J Ophthalmol. 2007 Mar-Apr;17(2):183-90
17415690
Br J Ophthalmol. 2007 Jan;91(1):62-8
16956912
Eur J Ophthalmol. 2006 Jan-Feb;16(1):73-80
16496249
Curr Med Res Opin. 2007 Mar;23(3):601-8
17355741
Am J Public Health Nations Health. 1966 Oct;56(10):1745-50
5951494
Eye (Lond). 2009 May;23(5):1098-110
18617908
Arch Ophthalmol. 2002 Jun;120(6):701-13; discussion 829-30
12049574
Ophthalmology. 2005 Aug;112(8):1337-42
16024084
Clin Ther. 2008 Apr;30(4):622-32
18498911
Ophthalmology. 2005 Jul;112(7):1177-85
15921747
Cochrane Database Syst Rev. 2005 Apr 18;(2):CD004399
15846712