Twelve studies involving 3048 patients with open-angle glaucoma or ocular hypertension were included in the meta-analysis comparing timolol with prostaglandin analogs «Li N, Chen XM, Zhou Y ym. Travoprost compared with...»1. Participants received either travoprost, other prostaglandin analog or timolol.
Travoprost 0.004 % caused a higher percentage of eyelash changes than timolol 0.5 % (OR = 38.81, 95 % CI 20.65-72.93, P < 0.00001). There was also an increased incidence of eyelash changes with travoprost 0.004 % than latanoptost 0.005 % (OR = 3.82, 95 % CI 2.50-5.84, P < 0.00001), or travoprost 0.0015 % (OR = 1.79, 95 % CI 1.40-2.27, P < 0.00001).
The 5-year, randomized, open-label safety study «Goldberg I, Li XY, Selaru P ym. A 5-year, randomiz...»3 compared once-daily latanoprost with usual care, defined as any commercially available IOP-reducing medication except latanoprost. The study was conducted at 406 centers in 14 countries. Patients were excluded if they had previously been or currently were being treated with latanoprost or another prostaglandin. In all, 5893 patients were randomized, and 5854 (99.3 %) received at least one dose of study medication.
The first subject visit occurred 1999, and the last was on 2005. In the total safety population, 3936 (67 %) patients were randomized to latanoprost, and 2707/3936 (69 %) completed the study. 1918 patients were initially randomized to usual care, and 1285/1918 (67 %) completed the study. At baseline, approximately 95 % of patients were receiving IOP-reducing medications, with 78 % being treated with ß-adrenergic antagonists and 20 % receiving topical carbonic anhydrase inhibitors. Among patients ever treated with latanoprost, 1871/4638 (40 %) experienced eyelash changes, and 363/4638 (8 %) had increased pigmentation of the periorbital skin.
The study of Inoue et al. (2012) «Inoue K, Shiokawa M, Higa R ym. Adverse periocular...»4 included 250 eyes from 250 patients diagnosed with primary open-angle glaucoma or ocular hypertension who were treated with either latanoprost, travoprost, tafluprost, bimatoprost, or isopropyl unoprostone for >3 months in only one eye. Photographs of both eyes were obtained, and the images were assessed by three ophthalmologists who were masked to treatment type. The existence of eyelid pigmentation and eyelash bristles was judged, and images of the left and right eyes were compared. Subjective symptoms regarding the existence of eyelid pigmentation and eyelash bristles were investigated through a questionnaire.
There was no significant difference between the five types of medications with regard to eyelid pigmentation (P=0.537). Use of isopropyl unoprostone resulted in a significantly lower incidence of eyelash bristles (P<0.0001). The questionnaire investigation showed that eyelid pigmentation and eyelash bristles were significantly more frequent with travoprost (42.0 % and 42.0 %, respectively) and bimatoprost (58.0 % and 60.0 %, respectively), and latanoprost (30 % and 28 %, respectively) and tafluprost (22 % and 34 %, respectively) and unoprostone (12 % and 8 %, respectively) compared with other three medications (P<0.0001).
The appearance frequency of eyelid pigmentation was similar among the five types of PG analogs studied, but eyelash bristles appeared less frequently with isopropyl unoprostone use.
In another meta-analysis comparing latanoprost with timolol in patients with open-angle glaucoma «Zhang WY, Po AL, Dua HS ym. Meta-analysis of rando...»2, latanoprost caused hyperaemia and iris pigmentation more often than timolol (RR = 2.20, 95 % CI 1.33-3.65). The number needed to harm was 21 (CI 14-42) when compared to timolol. Of 478 patients who were treated with latanoprost, 21 (4.39 %) developed iris pigmentation. In contrast, none of the patients treated with timolol showed this effect (0/387).
Comment: These changes are common and they should be explained to patients before treatment.