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Abstract #6505 Published in IGR 3-2
Meta-analysis of randomised controlled trials comparing latanoprost with timolol in the treatment of patients with open angle glaucoma or ocular hypertension
Zhang WY; Li Wan Po A; Dua HS; Azuara-Blanco ABritish Journal of Ophthalmology 2001; 85: 983-990
AIM: To evaluate the comparative efficacy and tolerance of latanoprost versus timolol through a meta-analysis of randomized controlled trials (RCTs). METHODS: Systematic retrieval of RCTs of latanoprost versus timolol to allow pooling of results from head-to-head comparison studies. Quality of trials was assessed based on randomization, masking, and withdrawal. Sensitivity analyses were used to estimate the effect of quality of study on outcomes. The data sources were Medline, Embase, Scientific Citation Index, Merck Glaucoma, and Pharmacia and Upjohn ophthalmology databases. There were 1256 patients with open-angle glaucoma or ocular hypertension reported in 11 trials of latanoprost versus timolol. The main outcome measures were: (1) percentage intraocular pressure (IOP) reduction for efficacy; (2) relative risk, risk difference, and number needed to hard for side-effects such as hyperemia, conjunctivitis, increased pigmentation, hypotension, and bradycardia expressed as dichotonomous outcomes; and (3) reduction in systemic blood pressure and heart rate as side-effects. RESULTS: Both 0.005% latanoprost once daily and 0.5% timolol twice daily reduced IOP. The percentage reductions in IOP from baseline (mean SE) produced by latanoprost and timolol were 30.2 (2.3) and 26.9 (3.4) at three months. The difference in IOP reduction between the two treatments was 5.0 (95% confidence intervals 2.8, 7.3). However, latanoprost caused iris pigmentation in more patients than timolol (relative risk = 8.01, 95% confidence intervals 1.87, 34.30). The two-year risk with latanoprost reached 18% (51/277). Hyperemia was also more often observed with latanoprost (relative risk = 2.20, 95% confidence intervals 1.33, 3.64). Timolol caused a significant reduction in heart rate of four beats/minute (95% confidence interval 2, 6). CONCLUSIONS: This meta-analysis suggests that latanoprost is more effective than timolol in lowering IOP. However, it often causes iris pigmentation. While current evidence suggests that this pigmentation is benign, careful lifetime evaluation of patients is still justified.
Dr W.Y. Zhang, Centre for Evidence-Based Pharmacotherapy, School of Life and Health Sciences, Aston University, Aston Triangle, Birmingham B4 7ET, UK. w.y.zhang@aston.ac.uk
Classification:
11.4 Prostaglandins (Part of: 11 Medical treatment)
