title: Intraocular pressure-lowering effects of commonly used fixed-combination drugs with timolol: a systematic review and meta-analysis.
abstract: BACKGROUND
  The first goal of medical therapy in glaucoma is to reduce intraocular pressure (IOP), and the fixed-combination medications are needed to achieve sufficiently low target IOP. The aim of this systematic review and meta-analysis is to evaluate IOP-lowering effect of the commonly used fixed-combination drugs containing 0.5% timolol.
  
  
  METHODS
  Pertinent publications were identified through systematic searches. Over 85% of the patients had to be diagnosed with primary open-angle glaucoma (POAG) or ocular hypertension (OHT). Forty-one randomized clinical trials were included in the meta-analysis. The main efficacy measures were the absolute and relative values of mean diurnal IOP reduction, and the highest and lowest IOP reductions on the diurnal IOP curve. The pooled 1- to 3-month IOP-lowering effects after a medicine-free washout period was calculated by performing meta-analysis using the random effects model, and relative treatment effects among different fixed combinations were assessed using a mixed-effects meta-regression model.
  
  
  RESULTS
  The relative reductions for mean diurnal IOP were 34.9% for travoprost/timolol, 34.3% for bimatoprost/timolol, 33.9% for latanoprost/timolol, 32.7% for brinzolamide/timolol, 29.9% for dorzolamide/timolol, and 28.1% for brimonidine/timolol. For the highest IOP decrease, relative reductions ranged from 31.3% for dorzolamide/timolol to 35.5% for travoprost/timolol; for the lowest IOP decrease, those varied from 25.9% for dorzolamide/timolol to 33.1% for bimatoprost/timolol. Both latanoprost/timolol and travoprost/timolol were more effective in lowering mean diurnal IOP than brimonidine/timolol (WMD: 5.9 and 7.0) and dorzolamide/timolol (WMD: 3.8 and 3.3).
  
  
  CONCLUSIONS
  All six commonly used fixed-combination drugs containing timolol can effectively lower IOP in patients with POAG and OHT, and both latanoprost/timolol and travoprost/timolol might achieve better IOP-lowering effects among the six fixed-combination agents.
authors.affiliation: Department of Ophthalmology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Jin-Wei
authors.initials: JW
authors.lastname: Cheng
authors.forename: Shi-Wei
authors.initials: SW
authors.lastname: Cheng
authors.forename: Lian-Di
authors.initials: LD
authors.lastname: Gao
authors.forename: Guo-Cai
authors.initials: GC
authors.lastname: Lu
authors.forename: Rui-Li
authors.initials: RL
authors.lastname: Wei
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000494:pharmacology*; D002940:Circadian Rhythm / Q000187:drug effects; D004338:Drug Combinations; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D013999:Timolol / Q000494:pharmacology*
chemical_list: D000959:Antihypertensive Agents; D004338:Drug Combinations; D013999:Timolol