Meta-analysis of randomised controlled trials comparing latanoprost with brimonidine in the treatment of open-angle glaucoma, ocular hypertension or normal-tension glaucoma

A. T. Fung, S. E. Reid, M. P. Jones, P. R. Healey, P. J. McCluskey, J. C. Craig

Research output: Contribution to journalReview articleResearchpeer-review

Abstract

Aim: To compare the efficacy and tolerability of latanoprost versus brimonidine in the treatment of open-angle glaucoma, ocular hypertension or normal-tension glaucoma. Method: Systematic review of randomised controlled trials comparing latanoprost and brimondine, identified by searches including Medline, Embase and Cochrane Controlled Trials Register. Two reviewers independently assessed trials for eligibility and quality and extracted data. Data were synthesised (random effects model) and expressed as the absolute mean intraocular pressure (IOP) reduction difference from baseline to end point for efficacy and relative risk for adverse events. Subgroup analysis and regression were used to explore heterogeneity according to patient characteristics, trial design and quality. Results: 15 publications reporting on 14 trials (1784 participants) were included for meta-analysis. IOP reduction favoured latanoprost (weighted mean difference (WMD) = 1.10 mm Hg (95% confidence interval (CI) 0.57 to 1.63)). Significant heterogeneity was present (χ2 13 = 38.29, p = 0.001, I2 = 66.0%). Subgroup analysis showed greater WMD for studies where data were analysed from end points >6 months duration, cross-over design, open-angle glaucoma or ocular hypertension and monotherapy. Multiple regression showed no significant association of WMD with trial duration (t9 = 1.92, p = 0.09), trial design (t9 = 1.79, p = 0.11), trial quality (t9 = -0.46, p = 0.66), or monotherapy or adjunctive therapy (t9 = -2.14, p = 0.06). Fatigue was less commonly associated with latanoprost (RR = 0.27, 95% CI 0.08 to 0.88). Publication bias was not evident on visual inspection of a funnel plot. Conclusion: Latanoprost is more effective than brimonidine as monotherapy in lowering IOP. Brimonidine is associated with a higher rate of fatigue.

LanguageEnglish
Pages62-68
Number of pages7
JournalBritish Journal of Ophthalmology
Volume91
Issue number1
DOIs
Publication statusPublished - Jan 2007
Externally publishedYes

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latanoprost
Low Tension Glaucoma
Ocular Hypertension
Open Angle Glaucoma
Meta-Analysis
Randomized Controlled Trials
Intraocular Pressure
Fatigue
Confidence Intervals
Therapeutics
Publication Bias
Cross-Over Studies
Publications
Regression Analysis
Brimonidine Tartrate

Bibliographical note

Copyright retained by the author(s). Article originally published in British journal of ophthalmology, Vol. 91, Iss. 1, pp. 62-68. The original article can be found at http://dx.doi.org.au/10.1136/bjo.2006.096693. Article archived for private and non-commercial use with the permission of the author and according to publisher conditions. For further information see http://www.bmj.com/.

Cite this

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title = "Meta-analysis of randomised controlled trials comparing latanoprost with brimonidine in the treatment of open-angle glaucoma, ocular hypertension or normal-tension glaucoma",
abstract = "Aim: To compare the efficacy and tolerability of latanoprost versus brimonidine in the treatment of open-angle glaucoma, ocular hypertension or normal-tension glaucoma. Method: Systematic review of randomised controlled trials comparing latanoprost and brimondine, identified by searches including Medline, Embase and Cochrane Controlled Trials Register. Two reviewers independently assessed trials for eligibility and quality and extracted data. Data were synthesised (random effects model) and expressed as the absolute mean intraocular pressure (IOP) reduction difference from baseline to end point for efficacy and relative risk for adverse events. Subgroup analysis and regression were used to explore heterogeneity according to patient characteristics, trial design and quality. Results: 15 publications reporting on 14 trials (1784 participants) were included for meta-analysis. IOP reduction favoured latanoprost (weighted mean difference (WMD) = 1.10 mm Hg (95{\%} confidence interval (CI) 0.57 to 1.63)). Significant heterogeneity was present (χ2 13 = 38.29, p = 0.001, I2 = 66.0{\%}). Subgroup analysis showed greater WMD for studies where data were analysed from end points >6 months duration, cross-over design, open-angle glaucoma or ocular hypertension and monotherapy. Multiple regression showed no significant association of WMD with trial duration (t9 = 1.92, p = 0.09), trial design (t9 = 1.79, p = 0.11), trial quality (t9 = -0.46, p = 0.66), or monotherapy or adjunctive therapy (t9 = -2.14, p = 0.06). Fatigue was less commonly associated with latanoprost (RR = 0.27, 95{\%} CI 0.08 to 0.88). Publication bias was not evident on visual inspection of a funnel plot. Conclusion: Latanoprost is more effective than brimonidine as monotherapy in lowering IOP. Brimonidine is associated with a higher rate of fatigue.",
author = "Fung, {A. T.} and Reid, {S. E.} and Jones, {M. P.} and Healey, {P. R.} and McCluskey, {P. J.} and Craig, {J. C.}",
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Meta-analysis of randomised controlled trials comparing latanoprost with brimonidine in the treatment of open-angle glaucoma, ocular hypertension or normal-tension glaucoma. / Fung, A. T.; Reid, S. E.; Jones, M. P.; Healey, P. R.; McCluskey, P. J.; Craig, J. C.

In: British Journal of Ophthalmology, Vol. 91, No. 1, 01.2007, p. 62-68.

Research output: Contribution to journalReview articleResearchpeer-review

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T1 - Meta-analysis of randomised controlled trials comparing latanoprost with brimonidine in the treatment of open-angle glaucoma, ocular hypertension or normal-tension glaucoma

AU - Fung, A. T.

AU - Reid, S. E.

AU - Jones, M. P.

AU - Healey, P. R.

AU - McCluskey, P. J.

AU - Craig, J. C.

N1 - Copyright retained by the author(s). Article originally published in British journal of ophthalmology, Vol. 91, Iss. 1, pp. 62-68. The original article can be found at http://dx.doi.org.au/10.1136/bjo.2006.096693. Article archived for private and non-commercial use with the permission of the author and according to publisher conditions. For further information see http://www.bmj.com/.

PY - 2007/1

Y1 - 2007/1

N2 - Aim: To compare the efficacy and tolerability of latanoprost versus brimonidine in the treatment of open-angle glaucoma, ocular hypertension or normal-tension glaucoma. Method: Systematic review of randomised controlled trials comparing latanoprost and brimondine, identified by searches including Medline, Embase and Cochrane Controlled Trials Register. Two reviewers independently assessed trials for eligibility and quality and extracted data. Data were synthesised (random effects model) and expressed as the absolute mean intraocular pressure (IOP) reduction difference from baseline to end point for efficacy and relative risk for adverse events. Subgroup analysis and regression were used to explore heterogeneity according to patient characteristics, trial design and quality. Results: 15 publications reporting on 14 trials (1784 participants) were included for meta-analysis. IOP reduction favoured latanoprost (weighted mean difference (WMD) = 1.10 mm Hg (95% confidence interval (CI) 0.57 to 1.63)). Significant heterogeneity was present (χ2 13 = 38.29, p = 0.001, I2 = 66.0%). Subgroup analysis showed greater WMD for studies where data were analysed from end points >6 months duration, cross-over design, open-angle glaucoma or ocular hypertension and monotherapy. Multiple regression showed no significant association of WMD with trial duration (t9 = 1.92, p = 0.09), trial design (t9 = 1.79, p = 0.11), trial quality (t9 = -0.46, p = 0.66), or monotherapy or adjunctive therapy (t9 = -2.14, p = 0.06). Fatigue was less commonly associated with latanoprost (RR = 0.27, 95% CI 0.08 to 0.88). Publication bias was not evident on visual inspection of a funnel plot. Conclusion: Latanoprost is more effective than brimonidine as monotherapy in lowering IOP. Brimonidine is associated with a higher rate of fatigue.

AB - Aim: To compare the efficacy and tolerability of latanoprost versus brimonidine in the treatment of open-angle glaucoma, ocular hypertension or normal-tension glaucoma. Method: Systematic review of randomised controlled trials comparing latanoprost and brimondine, identified by searches including Medline, Embase and Cochrane Controlled Trials Register. Two reviewers independently assessed trials for eligibility and quality and extracted data. Data were synthesised (random effects model) and expressed as the absolute mean intraocular pressure (IOP) reduction difference from baseline to end point for efficacy and relative risk for adverse events. Subgroup analysis and regression were used to explore heterogeneity according to patient characteristics, trial design and quality. Results: 15 publications reporting on 14 trials (1784 participants) were included for meta-analysis. IOP reduction favoured latanoprost (weighted mean difference (WMD) = 1.10 mm Hg (95% confidence interval (CI) 0.57 to 1.63)). Significant heterogeneity was present (χ2 13 = 38.29, p = 0.001, I2 = 66.0%). Subgroup analysis showed greater WMD for studies where data were analysed from end points >6 months duration, cross-over design, open-angle glaucoma or ocular hypertension and monotherapy. Multiple regression showed no significant association of WMD with trial duration (t9 = 1.92, p = 0.09), trial design (t9 = 1.79, p = 0.11), trial quality (t9 = -0.46, p = 0.66), or monotherapy or adjunctive therapy (t9 = -2.14, p = 0.06). Fatigue was less commonly associated with latanoprost (RR = 0.27, 95% CI 0.08 to 0.88). Publication bias was not evident on visual inspection of a funnel plot. Conclusion: Latanoprost is more effective than brimonidine as monotherapy in lowering IOP. Brimonidine is associated with a higher rate of fatigue.

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DO - 10.1136/bjo.2006.096693

M3 - Review article

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JO - British Journal of Ophthalmology

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