title: Comparative efficacy and tolerability of topical prostaglandin analogues for primary open-angle glaucoma and ocular hypertension.
abstract: OBJECTIVE
  To systematically review the efficacy and tolerability of 4 prostaglandin analogues (PGAs) as first-line monotherapies for intraocular pressure (IOP) lowering in adult patients with primary open-angle glaucoma or ocular hypertension.
  
  
  METHODS
  A literature search was performed in PubMed (1965-June 2013) and the Cochrane Library (1980-June 2013) using the search terms ocular hypertension, open-angle glaucoma, prostaglandin analogues, bimatoprost, latanoprost, tafluprost, and travoprost. Additional studies were searched from the reference lists of identified publications.
  
  
  METHODS
  In all, 32 randomized controlled trials comparing between PGAs (bimatoprost 0.03%, latanoprost 0.005%, tafluprost 0.0015%, and travoprost 0.004%) or PGA with timolol were selected.
  
  
  RESULTS
  A network meta-analysis was conducted. Using timolol as reference, the relative risks (RRs) of achieving treatment success, defined as the proportion of patients achieving at least 30% IOP reduction, with 95% CIs, were as follows: bimatoprost, 1.59 (1.28-1.98); latanoprost, 1.32 (1.00-1.74); travoprost, 1.33 (1.03-1.72); and tafluprost, 1.10 (0.85-1.42). The mean IOP reductions after 1 month were 1.98 (1.50-2.47), 1.01 (0.55-1.46), 1.08 (0.59-1.57), and 0.46 (-0.41 to 1.33) mm Hg, respectively, and the results were sustained at 3 months. Bimatoprost was associated with the highest risk of developing hyperemia, whereas latanoprost had the lowest risk, with RRs (95% CI) of 4.66 (3.49-6.23) and 2.30 (1.76-3.00), respectively.
  
  
  CONCLUSIONS
  Bimatoprost achieved the highest efficacy in terms of IOP reduction, whereas latanoprost had the most favorable tolerability profile. This review serves to guide selection of the optimal PGA agent for individual patient care in clinical practice.
authors.affiliation: Pharmacy & Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore liang_lin@nhg.com.sg.
authors.forename: Liang
authors.initials: L
authors.lastname: Lin
authors.affiliation: Pharmacy & Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore.
authors.forename: Ying Jiao
authors.initials: YJ
authors.lastname: Zhao
authors.affiliation: Department of Ophthalmology, National University Hospital, Singapore.
authors.forename: Paul T K
authors.initials: PT
authors.lastname: Chew
authors.affiliation: Department of Ophthalmology, National University Hospital, Singapore.
authors.forename: Chelvin C A
authors.initials: CC
authors.lastname: Sng
authors.affiliation: Department of Ophthalmology, Tan Tock Seng Hospital, Singapore.
authors.forename: Hon-Tym
authors.initials: HT
authors.lastname: Wong
authors.affiliation: Department of Ophthalmology, Tan Tock Seng Hospital, Singapore.
authors.forename: Leonard W
authors.initials: LW
authors.lastname: Yip
authors.affiliation: Department of Pharmacy, National University Hospital, Singapore.
authors.forename: Tuck Seng
authors.initials: TS
authors.lastname: Wu
authors.affiliation: Singapore Clinical Research Institute.
authors.forename: Dianne
authors.initials: D
authors.lastname: Bautista
authors.affiliation: Pharmacy & Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore.
authors.forename: Monica
authors.initials: M
authors.lastname: Teng
authors.affiliation: Pharmacy & Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore.
authors.forename: Ai Leng
authors.initials: AL
authors.lastname: Khoo
authors.affiliation: Pharmacy & Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore.
authors.forename: Boon Peng
authors.initials: BP
authors.lastname: Lim
mesh_terms: D000577:Amides / Q000009:adverse effects / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000069580:Bimatoprost; D003008:Cloprostenol / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D005902:Glaucoma, Open-Angle / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D000077338:Latanoprost; D009798:Ocular Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D011460:Prostaglandins F / Q000009:adverse effects / Q000627:therapeutic use; D011461:Prostaglandins F, Synthetic / Q000009:adverse effects / Q000627:therapeutic use; D011465:Prostaglandins, Synthetic / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D013999:Timolol / Q000627:therapeutic use; D000069557:Travoprost
chemical_list: D000577:Amides; D000959:Antihypertensive Agents; D011460:Prostaglandins F; D011461:Prostaglandins F, Synthetic; D011465:Prostaglandins, Synthetic; C485333:tafluprost; D003008:Cloprostenol; D000077338:Latanoprost; D013999:Timolol; D000069580:Bimatoprost; D000069557:Travoprost
keywords: bimatoprost; glaucoma; intraocular pressure; latanoprost; meta-analysis; network meta-analysisIntroduction; ocular hypertension; systematic review; tafluprost; travoprost