Efficacy and tolerability of mono-compound topical treatments for reduction of intraocular pressure in patients with primary open angle glaucoma or ocular hypertension: an overview of reviews

Daka, Qëndresë and Trkulja, Vladimir (2014) Efficacy and tolerability of mono-compound topical treatments for reduction of intraocular pressure in patients with primary open angle glaucoma or ocular hypertension: an overview of reviews. Croatian Medical Journal, 55 (5). pp. 468-480. ISSN 0353-9504

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Abstract

AIM To evaluate the existing evidence on relative efficacy and tolerability of topical mono-compound intraocular pressure (IOP)-lowering drugs in treatment of primary open angle glaucoma (POAG) and ocular hypertension (OHT). METHODS In this systematic review of systematic reviews/meta-analyses of randomized controlled trials a thorough and sensitive search of PubMed, Embase and Cochrane Databases was performed. Individual study methodological quality and quality of evidence were assessed using the AMSTAR checklist and the GRADE system, respectively. The relationships between individual drugs were evaluated based on the best available evidence. RESULTS Of the 133 initial non-duplicate records, 16 studies met the inclusion criteria. Five achieved an overall "moderate" (none achieved "high") quality of evidence and evaluated prostaglandin analogues (PGAs) - latanoprost, travoprost, and bimatoprost; timolol; "other beta-blockers;" carbonic anhydrase inhibitors (CAI) as a group or dorzolamide separately; and brimonidine. "Moderate quality" refers to efficacy and incidence of conjunctival hyperemia. Quality of evidence regarding other tolerability aspects was low. PGAs should be considered equivalent regarding efficacy, but latanoprost was relevantly better tolerated than the other two. Non-PGA compounds did not relevantly differ between each other in either efficacy or safety. Timolol and brimonidine were relevantly less effective than all PGAs. The same was true for CAI vs bimatoprost. Regarding tolerability, timolol was superior to all PGAs and brimonidine and CAI were superior to bimatoprost. CONCLUSION No high quality evidence on relative efficacy and tolerability of the most commonly used mono-compound IOP-lowering drugs for POAG/OHT exists. Moderate quality evidence indicates latanoprost as a treatment with the most favorable trade-off between benefits and harms.

Abstract in Croatian

Učinkovitost i tolerabilnost monoterapijskog topikalnog liječenja za smanjenje intraokularnog tlaka kod pacijenata s primarnim glaukomom otvorenog kuta ili okularnom hipertenzijom: pregled preglednih radova ----- Cilj Ocijeniti postojeće dokaze o relativnoj učinkovitosti i tolerabilnosti topikalnih monoterapijskih lijekova za snižavanje intraokularnog tlaka kod liječenja primarnog glaukoma otvorenog kuta i okularne hipertenzije. ----- Postupci U ovom sustavnom preglednom radu sustavnih preglednih radova/meta-analiza randomiziranih kontroliranih pokusa detaljno smo i senzitivno pretražili baze podataka PubMed, Embase i Cochrane. Određivali smo metodološku kvalitetu i kvalitetu dokaza pojedinačnih istraživanja koristeći AMSTAR popis, odnosno GRADE sustav. Odnosi između pojedinačnih lijekova ocijenjeni su na temelju najboljih dostupnih dokaza. ----- Rezultati Od 133 početnih ne-duplikatnih zapisa, kriterije uključivanja zadovoljilo je 16 istraživanja. Pet istraživanja imao je „umjerenu“ kvalitetu dokaza (nijedno nije imalo „visoku” kvalitetu), a ta istraživanja bavila su se lijekovima analognim prostaglandinu (eng, PGA) – latanoprostom, travoprostom i bimatoprostom; timololom; „ostalim beta-blokatorima;“ inhibitorima karboanhidraze kao skupinom ili dorzolamidom posebno; te brimonidinom. „Umjerena” kvaliteta odnosi se na učinkovitost i incidenciju hiperemije konjuktive. Kvaliteta dokaza što se tiče ostalih aspekata tolerabilnosti bila je niska. PGA lijekovi mogu se smatrati ekvivalentnima, iako se latanoprost podnosio relativno bolje nego ostala dva. Ne-PGA lijekovi nisu se bitno međusobno razlikovali što se tiče učinkovitosti ili sigurnosti. Timolol i brimonidin bili su bitno manje učinkoviti nego svi PGA lijekovi. Isto vrijedi i za inhibitore karboanhidraze u usporedbi s bimatoprostom. Što se tiče tolerabilnosti, timolol je bio bolji nego svi PGA lijekovi, a brimonidin i inhibitorikarboanhidraze bili su bolji od bimatoprosta. ----- Zaključak Ne postoje dokazi visoke kvalitete o relativnoj učinkovitosti i tolerabilnosti najčešće korištenih monoterapijskih lijekova za snižavanje intraokularnog tlaka kod liječenja primarnog glaukoma otvorenog kuta ili okularne hipertenzije. Dokazi umjerene kvalitete ukazuju da latanoprost ima najbolji omjer povoljnih u odnosu na štetne učinke.

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