The efficacy of the fixed combination of latanoprost and timolol versus other fixed combinations for primary open-angle glaucoma and ocular hypertension: A systematic review and meta-analysis

Yi Xing, Lijuan Zhu, Ke Zhang, Shaohua Huang, Yi Xing, Lijuan Zhu, Ke Zhang, Shaohua Huang

Abstract

Background: Fixed-combination (FC) therapy is used in primary open-angle glaucoma (POAG) and ocular hypertension (OHT) patients who require more than one medication to reach their target intraocular pressure (IOP). Currently, there are several FC therapies available for the treatment of glaucoma. The FC of latanoprost/timolol (LTFC) is a commonly used FC. Here, we conducted systematic review to compare the IOP-lowering effects of LTFC with other FCs for patients with POAG and OHT.

Materials and methods: We searched PubMed, EMBASE, the Cochrane Library, and Web of Science for randomized-controlled clinical trials and cross-over studies. The outcomes were mean IOP and IOP fluctuation after one month of treatment. Meta-analysis was carried out using RevMan (version 5.1) software. After conducting meta-analyses, we rated the quality of each meta-analysis as high, moderate, low, or very low using the "GRADE" system.

Results: We included 16 trials in this meta-analysis. Moderate-quality meta-analysis showed that LTFC had a comparable mean IOP to that of a fixed combination of travoprost and timolol (TTFC) [mean difference (MD): 0.07 mmHg] and a fixed combination of dorzolamide and timolol (DTFC) [MD: -0.31 mmHg], and it also had a comparable IOP-fluctuation effect compared to that of TTFC [MD: 0.13 mm Hg] and DTFC [MD: 0.25 mmHg]. Compared to the fixed combination of bimatoprost and timolol (BiTFC), moderate-quality evidence showed a higher mean IOP in the LTFC group [MD 0.76 mmHg], whereas low-quality meta-analysis showed higher IOP fluctuation [MD 1.09 mmHg] in the LTFC group.

Conclusions: LTFC is as effective as TTFC and DTFC, but worse than BiTFC in controlling mean IOP and IOP fluctuation for POAG or OHT patients. The quality of our meta-analyses was assessed as moderate, with the exception of one low-quality analysis that compared the IOP fluctuation of LTFC and BiTFC.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Flow diagram of the study…
Fig 1. Flow diagram of the study selection as per the PRISMA statement.
Fig 2. Forest plot of the mean…
Fig 2. Forest plot of the mean IOP, comparison of LTFC and TTFC.
Fig 3. Forest plot of the mean…
Fig 3. Forest plot of the mean IOP, comparison of LTFC and BiTFC.
Fig 4. Forest plot of the mean…
Fig 4. Forest plot of the mean IOP, comparison of LTFC and DTFC.
Fig 5. Forest plot of the IOP…
Fig 5. Forest plot of the IOP fluctuation, comparison of LTFC and TTFC.
Fig 6. Forest plot of the IOP…
Fig 6. Forest plot of the IOP fluctuation, comparison of LTFC and BiTFC.
Fig 7. Forest plot of the IOP…
Fig 7. Forest plot of the IOP fluctuation, comparison of LTFC and DTFC.

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