Efficacy and safety of prostaglandin analogues in patients with predominantly primary open-angle glaucoma or ocular hypertension: a meta-analysis

Original Research

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Authors: Oghenowede Eyawo, Jean Nachega, Pierre Lefebvre, et al

Published Date July 2009 Volume 2009:3 Pages 447 - 456

DOI: http://dx.doi.org/10.2147/OPTH.S6501

Oghenowede Eyawo¹, Jean Nachega^2,3, Pierre Lefebvre⁴, David Meyer⁵, Beth Rachlis⁶, Chia-Wen Lee⁷, Steven Kelly⁷, Edward Mills⁸

¹Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada; ²Division of Clinical Pharmacology and Medicine, University of Cape Town, Cape Town, South Africa; ³Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; ⁴Department of Ophthalmology, Moorfields Eye Hospital, London, United Kingdom; ⁵Department of Ophthalmology, Stellenbosch University, Cape Town, South Africa; ⁶Department of Public Health, University of Toronto, Toronto, Canada; ⁷Outcome Research and Evidence Based Medicine, Pfizer Ltd UK. Tadworth, UK; ⁸Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada

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).

Conclusion: Randomized head-to-head evaluations of prostaglandin therapy demonstrate similar efficacy effects, but differing hyperemia effects.

Keywords: prostaglandin analogues, primary open-angle glaucoma, ocular hypertension, travoprost, latanoprost, bimatoprost

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