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Prostaglandins offer better results in lowering IOP at 3 months in POAG
Researchers found that prostaglandins lowered intraoperative pressure at 3 months better than beta-blockers, alpha-agonists or carbonic anhydrase in 114 clinical trials on primary open-angle glaucoma treatment.
Li and colleagues, in a study reported in Ophthalmology, said they included randomized controlled trials that compared a single active topical medication with no treatment/placebo or another single topical medication.
A total of 20,275 participants and 114 trials were included from a search of CENTRAL, MEDLINE, EMBASE and the FDA’s website.
At 3 months, the mean reduction in IOP from most to least effective were: bimatoprost with 5.61 mm Hg, latanoprost with 4.85 mm Hg, travoprost with 4.83 mm Hg, levobunolol with 4.51 mm Hg, tafluprost with 4.37 mm Hg, timolol with 3.70 mm Hg, brimonidine with 3.59 mm Hg, brinzolamide with 2.42 mm Hg, betaxolol with 2.24 mm Hg and unoprostone with 1.91 mm Hg, they reported..
The researchers found that timolol was the most often used comparator and was studied in 70 trials.
The researchers concluded that bitmatoprost, latanoprost and travoprost are among the most efficacious; however, within-class differences were narrow and may not have clinical significance.
“All factors, including side effects, patient preferences and cost, should be considered in selecting a drug for a given patient,” the authors concluded. – by Abigail Sutton
Disclosure: David S. Friedman, MD, PhD, reports he is a consultant for Allergan, Alcon and Foresight.
Perspective
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My first patient today has advanced normotensive glaucoma, has a treatment plan adherent on multiple topical medications and meets an IOP goal of 10 mmHg OU. Sounds good, huh? Unfortunately, he is experiencing progressive field loss, and I noted a disc hemorrhage in his worse eye.
My treatment options? I can monitor with fingers crossed or try, likely in vain, to further lower IOP.
We all agree that glaucoma is much more than elevated IOP, but our only treatment option is lowering IOP. With this frustrating backdrop, let’s look at Li and colleagues’ ambitious analysis of the IOP-lowering abilities of our currently available topical medications. Not surprisingly, the prostaglandin analogs were found to be most efficacious. Interestingly, timolol was found to lower IOP a bit more than brimonidine or brinzolamide. What did I take away from this study?
I prescribe timolol often. In my hands it is effective and well tolerated in patients without a beta-blocker contraindication. Colleagues and experts may frown on this choice, but it works for me.
Besides feeling better about prescribing timolol, this study has me yearning for treatment advances beyond IOP lowering. And, please, let’s have a revolution in glaucoma treatment before I’m forced to buy another marginally useful, high-tech glaucoma detection device.