title: Comparing the efficacy of latanoprost (0.005%), bimatoprost (0.03%), travoprost (0.004%), and timolol (0.5%) in the treatment of primary open angle glaucoma.
abstract: OBJECTIVE
  To compare the efficacy and safety of latanoprost, bimatoprost, travoprost and timolol in reducing intraocular pressure (IOP) in patients with primary open angle glaucoma.
  
  
  METHODS
  This was a prospective study conducted at a tertiary-care centre. One hundred and forty patients with newly diagnosed primary open angle glaucoma were randomly assigned to treatment with latanoprost (0.005%), bimatoprost (0.03%), travoprost (0.004%) or timolol gel (0.5%); 35 patients were assigned to each group. All patients were followed for 2, 6, and 12 weeks. The main outcome measure studied was the change in IOP at week 12 from the baseline values. Safety measures included recording of adverse events.
  
  
  RESULTS
  The mean IOP reduction from baseline at week 12 was significantly more with bimatoprost (8.8 mmHg, 35.9%) than with latanoprost (7.3 mmHg, 29.9%), travoprost (7.6 mmHg, 30.8%) or timolol (6.7 mmHg, 26.6%) (ANOVA and Student's t-tests, p < 0.001). Among the prostaglandins studied, bimatoprost produced a maximum reduction in IOP (-2.71; 95% confidence interval [CI], -2.25 to -3.18) followed by travoprost (-1.27; 95% CI, -0.81 to -1.27) and latanoprost (-1.25; 95% CI, -0.79 to -1.71); these values were significant when compared to timolol at week 12 (Bonferroni test, p < 0.001). Latanoprost and travoprost were comparable in their ability to reduce IOP at each patient visit. Ocular adverse-events were found in almost equal proportion in patients treated with bimatoprost (41.3%) and travoprost (41.9%), with a higher incidence of conjunctival hyperemia (24.1%) seen in the bimatoprost group. Timolol produced a significant drop in heart rate (p < 0.001) at week 12 when compared to the baseline measurements.
  
  
  CONCLUSIONS
  Bimatoprost showed greater efficacy when compared to the other prostaglandins, and timolol was the most efficacious at lowering the IOP. Conjunctional hyperemia was mainly seen with bimatoprost. However, the drug was tolerated well and found to be safe.
authors.affiliation: Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Mishra
authors.affiliation: Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, India.
authors.forename: Bibhuti Prassan
authors.initials: BP
authors.lastname: Sinha
authors.affiliation: Department of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
authors.forename: Mahendra Singh
authors.initials: MS
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000069580:Bimatoprost / Q000009:adverse effects / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D005902:Glaucoma, Open-Angle / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D000077338:Latanoprost; D008297:Male; D008875:Middle Aged; D011461:Prostaglandins F, Synthetic / Q000009:adverse effects / Q000627:therapeutic use; D013999:Timolol / Q000009:adverse effects / Q000627:therapeutic use; D014065:Tonometry, Ocular; D000069557:Travoprost / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome; D014792:Visual Acuity / Q000187:drug effects; D058609:Visual Field Tests; D014794:Visual Fields / Q000187:drug effects
chemical_list: D000959:Antihypertensive Agents; D011461:Prostaglandins F, Synthetic; D000077338:Latanoprost; D013999:Timolol; D000069580:Bimatoprost; D000069557:Travoprost
keywords: Primary open angle glaucoma; Prostaglandins; Timolol