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Intraocular pressure-lowering effects of all commonly used glaucoma drugs: a meta-analysis of randomized clinical trials.

Abstract

OBJECTIVE

To estimate the intraocular pressure (IOP) reduction achieved by the most frequently prescribed glaucoma drugs and a placebo in a meta-analysis of randomized clinical trials.

DESIGN

Meta-analysis of randomized clinical trials.

PARTICIPANTS

Twenty-seven articles reporting on 28 randomized clinical trials. These articles reported 6953 participants for the trough and 6841 for the peak.

METHODS

Articles published up to December 2003 were identified in the following data sources: Medline, Embase, and the Cochrane Controlled Trials Register, and references from relevant articles. Over 85% of the patients had to be diagnosed with primary open-angle glaucoma (POAG) or ocular hypertension (OH), and articles had to be written in English, German, French, or Dutch. Quality of trials was assessed by a Delphi list with additions. The pooled 1-month IOP-lowering effect from baseline at peak and trough was calculated by performing meta-analysis using the random effects model.

MAIN OUTCOME MEASURES

Absolute and relative change in IOP from baseline, for peak and trough moments.

RESULTS

Relative IOP reductions from baseline [mean (95% confidence interval)] were -23% (-25% to -22%) for a peak and -20% (-23% to -17%) for a trough for 0.5% betaxolol; peak, -27% (-29% to -25%), and trough, -26% (-28% to -25%), for 0.5% timolol; peak, -22% (-24% to -20%), and trough, -17% (-19% to -15%), for 2.0% dorzolamide; peak, -17% (-19% to -15%), and trough, -17% (-19% to -15%) for 1.0% brinzolamide; peak, -25% (-28% to -22%), and trough, -18% (-21% to -14%) for 0.2% brimonidine; peak, -31% (-33% to -29%), and trough, -28% (-30% to -26%) for 0.005% latanoprost; peak, -31% (-32% to -29%), and trough, -29% (-32% to -25%) for 0.004% travoprost; peak, -33% (-35% to -31%), and trough, -28% (-29% to -27%) for 0.03% bimatoprost; and peak, -5% (-9% to -1%), and trough, -5% (-10% to -0%) for the placebo. The difference in absolute IOP reduction from baseline between timolol and prostaglandin analogs or prostamide varied from -0.4 to 0.1 mmHg at trough and from 1.0 to 1.5 mmHg at peak. Quality scores of included studies were generally high, a mean of 14.2 on a scale from 0 to 20 (interquartile range, 13-16).

CONCLUSION

This meta-analysis suggests that bimatoprost, travoprost, latanoprost, and timolol are the most effective intraocular pressure-reducing agents in POAG and OH patients.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.

    , , , ,

    Source

    Ophthalmology 112:7 2005 Jul pg 1177-85

    MeSH

    Adrenergic alpha-Agonists
    Adrenergic beta-Antagonists
    Antihypertensive Agents
    Drug Prescriptions
    Glaucoma, Open-Angle
    Humans
    Intraocular Pressure
    Ocular Hypertension
    Prostaglandins, Synthetic
    Randomized Controlled Trials as Topic
    Timolol

    Pub Type(s)

    Comparative Study
    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    15921747

    Citation

    van der Valk, Rikkert, et al. "Intraocular Pressure-lowering Effects of All Commonly Used Glaucoma Drugs: a Meta-analysis of Randomized Clinical Trials." Ophthalmology, vol. 112, no. 7, 2005, pp. 1177-85.
    van der Valk R, Webers CA, Schouten JS, et al. Intraocular pressure-lowering effects of all commonly used glaucoma drugs: a meta-analysis of randomized clinical trials. Ophthalmology. 2005;112(7):1177-85.
    van der Valk, R., Webers, C. A., Schouten, J. S., Zeegers, M. P., Hendrikse, F., & Prins, M. H. (2005). Intraocular pressure-lowering effects of all commonly used glaucoma drugs: a meta-analysis of randomized clinical trials. Ophthalmology, 112(7), pp. 1177-85.
    van der Valk R, et al. Intraocular Pressure-lowering Effects of All Commonly Used Glaucoma Drugs: a Meta-analysis of Randomized Clinical Trials. Ophthalmology. 2005;112(7):1177-85. PubMed PMID: 15921747.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Intraocular pressure-lowering effects of all commonly used glaucoma drugs: a meta-analysis of randomized clinical trials. AU - van der Valk,Rikkert, AU - Webers,Carroll A B, AU - Schouten,Jan S A G, AU - Zeegers,Maurice P, AU - Hendrikse,Fred, AU - Prins,Martin H, PY - 2004/10/08/received PY - 2005/01/11/accepted PY - 2005/6/1/pubmed PY - 2005/7/19/medline PY - 2005/6/1/entrez SP - 1177 EP - 85 JF - Ophthalmology JO - Ophthalmology VL - 112 IS - 7 N2 - OBJECTIVE: To estimate the intraocular pressure (IOP) reduction achieved by the most frequently prescribed glaucoma drugs and a placebo in a meta-analysis of randomized clinical trials. DESIGN: Meta-analysis of randomized clinical trials. PARTICIPANTS: Twenty-seven articles reporting on 28 randomized clinical trials. These articles reported 6953 participants for the trough and 6841 for the peak. METHODS: Articles published up to December 2003 were identified in the following data sources: Medline, Embase, and the Cochrane Controlled Trials Register, and references from relevant articles. Over 85% of the patients had to be diagnosed with primary open-angle glaucoma (POAG) or ocular hypertension (OH), and articles had to be written in English, German, French, or Dutch. Quality of trials was assessed by a Delphi list with additions. The pooled 1-month IOP-lowering effect from baseline at peak and trough was calculated by performing meta-analysis using the random effects model. MAIN OUTCOME MEASURES: Absolute and relative change in IOP from baseline, for peak and trough moments. RESULTS: Relative IOP reductions from baseline [mean (95% confidence interval)] were -23% (-25% to -22%) for a peak and -20% (-23% to -17%) for a trough for 0.5% betaxolol; peak, -27% (-29% to -25%), and trough, -26% (-28% to -25%), for 0.5% timolol; peak, -22% (-24% to -20%), and trough, -17% (-19% to -15%), for 2.0% dorzolamide; peak, -17% (-19% to -15%), and trough, -17% (-19% to -15%) for 1.0% brinzolamide; peak, -25% (-28% to -22%), and trough, -18% (-21% to -14%) for 0.2% brimonidine; peak, -31% (-33% to -29%), and trough, -28% (-30% to -26%) for 0.005% latanoprost; peak, -31% (-32% to -29%), and trough, -29% (-32% to -25%) for 0.004% travoprost; peak, -33% (-35% to -31%), and trough, -28% (-29% to -27%) for 0.03% bimatoprost; and peak, -5% (-9% to -1%), and trough, -5% (-10% to -0%) for the placebo. The difference in absolute IOP reduction from baseline between timolol and prostaglandin analogs or prostamide varied from -0.4 to 0.1 mmHg at trough and from 1.0 to 1.5 mmHg at peak. Quality scores of included studies were generally high, a mean of 14.2 on a scale from 0 to 20 (interquartile range, 13-16). CONCLUSION: This meta-analysis suggests that bimatoprost, travoprost, latanoprost, and timolol are the most effective intraocular pressure-reducing agents in POAG and OH patients. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/15921747/Intraocular_pressure_lowering_effects_of_all_commonly_used_glaucoma_drugs:_a_meta_analysis_of_randomized_clinical_trials_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(05)00286-1 DB - PRIME DP - Unbound Medicine ER -