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A network meta-analysis combined direct and indirect comparisons between glaucoma drugs to rank effectiveness in lowering intraocular pressure.

Abstract

OBJECTIVE

It is difficult to rank treatments according to their effect size when several treatments are available and not all treatments have been compared directly. The purpose of this study was to show a new statistical technique (network meta-analysis) to address this problem and to rank glaucoma drugs according to their intraocular pressure (IOP)-reducing effect.

STUDY DESIGN AND SETTING

Network meta-analysis of randomized controlled trials was used to combine direct and indirect estimates of the effect of eight drugs and placebo from 28 randomized controlled trials in patients with primary open-angle glaucoma or ocular hypertension patients, 6,841 for the peak effect and 6,953 patients for the trough effect.

RESULTS

All drugs differ from placebo in lowering IOP. At the peak, the rank order from high to low in terms of the mean IOP reduction reached is bimatoprost, travoprost and latanoprost, brimonidine, timolol, dorzolamide, betaxolol, brinzolamide. At the trough, this rank order is bimatoprost, latanoprost, travoprost, timolol, betaxolol, dorzolamide, brinzolamide, brimonidine. The results based on direct or indirect estimates were similar. This ranking differed from the ranking based on the mean IOP change from baseline of all arms including the study drug from all randomized controlled trials.

CONCLUSIONS

A network meta-analysis can be used to combine direct and indirect treatment effects in a formal way. Applied to glaucoma medications, it shows that there is a rank order in treatment effects on IOP.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Ophthalmology, Maastricht University Hospital, The Netherlands.

    , , , ,

    Source

    Journal of clinical epidemiology 62:12 2009 Dec pg 1279-83

    MeSH

    Antihypertensive Agents
    Data Interpretation, Statistical
    Glaucoma, Open-Angle
    Humans
    Intraocular Pressure
    Ocular Hypertension
    Randomized Controlled Trials as Topic
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Meta-Analysis

    Language

    eng

    PubMed ID

    19716679

    Citation

    van der Valk, Rikkert, et al. "A Network Meta-analysis Combined Direct and Indirect Comparisons Between Glaucoma Drugs to Rank Effectiveness in Lowering Intraocular Pressure." Journal of Clinical Epidemiology, vol. 62, no. 12, 2009, pp. 1279-83.
    van der Valk R, Webers CA, Lumley T, et al. A network meta-analysis combined direct and indirect comparisons between glaucoma drugs to rank effectiveness in lowering intraocular pressure. J Clin Epidemiol. 2009;62(12):1279-83.
    van der Valk, R., Webers, C. A., Lumley, T., Hendrikse, F., Prins, M. H., & Schouten, J. S. (2009). A network meta-analysis combined direct and indirect comparisons between glaucoma drugs to rank effectiveness in lowering intraocular pressure. Journal of Clinical Epidemiology, 62(12), pp. 1279-83. doi:10.1016/j.jclinepi.2008.04.012.
    van der Valk R, et al. A Network Meta-analysis Combined Direct and Indirect Comparisons Between Glaucoma Drugs to Rank Effectiveness in Lowering Intraocular Pressure. J Clin Epidemiol. 2009;62(12):1279-83. PubMed PMID: 19716679.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - A network meta-analysis combined direct and indirect comparisons between glaucoma drugs to rank effectiveness in lowering intraocular pressure. AU - van der Valk,Rikkert, AU - Webers,Carroll A B, AU - Lumley,Thomas, AU - Hendrikse,Fred, AU - Prins,Martin H, AU - Schouten,Jan S A G, Y1 - 2009/08/28/ PY - 2007/05/25/received PY - 2008/04/14/revised PY - 2008/04/26/accepted PY - 2009/9/1/entrez PY - 2009/9/1/pubmed PY - 2010/3/24/medline SP - 1279 EP - 83 JF - Journal of clinical epidemiology JO - J Clin Epidemiol VL - 62 IS - 12 N2 - OBJECTIVE: It is difficult to rank treatments according to their effect size when several treatments are available and not all treatments have been compared directly. The purpose of this study was to show a new statistical technique (network meta-analysis) to address this problem and to rank glaucoma drugs according to their intraocular pressure (IOP)-reducing effect. STUDY DESIGN AND SETTING: Network meta-analysis of randomized controlled trials was used to combine direct and indirect estimates of the effect of eight drugs and placebo from 28 randomized controlled trials in patients with primary open-angle glaucoma or ocular hypertension patients, 6,841 for the peak effect and 6,953 patients for the trough effect. RESULTS: All drugs differ from placebo in lowering IOP. At the peak, the rank order from high to low in terms of the mean IOP reduction reached is bimatoprost, travoprost and latanoprost, brimonidine, timolol, dorzolamide, betaxolol, brinzolamide. At the trough, this rank order is bimatoprost, latanoprost, travoprost, timolol, betaxolol, dorzolamide, brinzolamide, brimonidine. The results based on direct or indirect estimates were similar. This ranking differed from the ranking based on the mean IOP change from baseline of all arms including the study drug from all randomized controlled trials. CONCLUSIONS: A network meta-analysis can be used to combine direct and indirect treatment effects in a formal way. Applied to glaucoma medications, it shows that there is a rank order in treatment effects on IOP. SN - 1878-5921 UR - https://www.unboundmedicine.com/medline/citation/19716679/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0895-4356(09)00176-0 DB - PRIME DP - Unbound Medicine ER -