Systematic review 1
In a systematic review, different monotherapies were compared with each other among patients suffering from glaucoma and ocular hypertension. Altogether 114 articles fulfilled the preset criteria. In these articles the follow-up time was at least 3 months and they were published in 1983-2013 «Li T, Lindsley K, Rouse B ym. Comparative Effectiv...»1.
The most effective drug class was prostaglandin analogs and a mean IOP reductions were;
| Mean mmHg | 95% CI | |
|---|---|---|
| Bimatoprost | 5.61 | 4.94-6.29 |
| Latanoprost | 4.85 | 4.24-5.46 |
| Travoprost | 4,83 | 4.12-5.54 |
| Tafluprost | 4,37 | 2,94-5,83 |
| Timolol | 3.70 | 3.16-4.24 |
| Brimonidine | 3,59 | 2.89-4.29 |
| Brinzolamide | 2.42 | 1.62-3.23 |
| Dorzolamide | 2.49 | 1.85-3.13 |
Tutkimuksen laatu: hyvä
Sovellettavuus suomalaiseen väestöön: hyvä
Systematic Review 2
Systematic review in 2018 studied all common glaucoma monotherapies and combination drugs. Original studies were randomized controlled clinical trials and duration was at minimum 3 months. After data analysis, 50 original studies were selected for further review. In statistical analysis rankogram was prepared to rank each treatment according to decreasing IOP. In the ranking, the more negative the grade, the lower is the effect.
According to results prostaglandin analogs had highest probability to lower IOP when compared with timolol -5,94 mmHg (CI -7,61 - -4,27), -6,07 mmHg compared with brimonidine (CI -8,53 - -3,61) and -9,10 mmHg (CI 11,55 - -6,65) when compared with carbonic anhydrase inhibitors. Placebo was -18,55 mmHg (CI -24,39 - -12,70) in this scale «Li F, Huang W, Zhang X. Efficacy and safety of dif...»2.
| Rankogram vs. prostaglandins | mmHg | 95 % CI |
|---|---|---|
| Timolol | -5.94 | -7.61 to - 4.27 |
| Brimonidine | -6.07 | -8.53 to - 3.61 |
| Carbonic anhydrase inhibitors | -9.10 | - 11,55 to - 6.65 |
| Placebo | -18,55 | - 24.39 to -12.70 |
Tutkimuksen laatu: hyvä
Sovellettavuus suomalaiseen väestöön: hyvä.
Kommentti: tutkimuksessa ei tuotu esille oliko brimonidiinista valittu huippu (peak 2 tuntia) vai juuri ennen seuraavaa annostelua (trough 12 tuntia).
Systematic Review 3
A network meta-analysis was used as a method to compare individual monotherapies with each other. Data comprised of 28 randomized controlled clinical trials and patients suffered from glaucoma or ocular hypertension. When timolol was used as a 0-reference and the scale was relative, data revealed that prostaglandin analogies had highest effectiveness; for bimatoprost relative IOP difference to timolol was -6 mmHg (CI -8 - -4), travoprosti -3 mmHg (CI -5 - -1) and latanoprost -3 mmHg (CI -4 - -1). Less effective than timolol were betaksolol 5 mmHg (CI 3-8), dorzolamide 6 mmHg (CI 3-8), brinzolamide 6 mmHg (CI 3-9), brimonidine 7 mmHg (CI 4-10), and placebo got value 15mmHg (CI 13-17) «Li F, Huang W, Zhang X. Efficacy and safety of dif...»3
| Rankogram vs. timolol | mmHg | CI |
|---|---|---|
| Bimatoprost | -6 | -8 to - 4 |
| Travoprost | -3 | -5 to - 1 |
| Latanoprost | -3 | -4 to - 1 |
| Betaxalol | 3 to 8 | |
| Dorzolamide | 6 | 3 to 8 |
| Brinzolmide | 6 | 3 to 9 |
| Brimonidine | 7 | 4 to 10 |
| Placebo | 15 | 13 to 17 |
Tutkimuksen laatu: tasokas
Sovellettavuus suomalaiseen väestöön: hyvä.
Kommentti: Verkostoanalyysi mahdollistaa epäsuoran vertailun lääkeaineiden välillä ja tuo parhaiten esille suhteellisia eroja.