The differences between combination drugs in the reduction of intraocular pressure are small. The combination of prostaglandin analogues and timolol may decrease intraocular pressure more than other combination drugs.
Systematic review 1
Systematic review in 2018 studied all common glaucoma monotherapies and combination drugs. Original studies were randomized controlled clinical trials lasting minimum 3 months. After data analysis 50 original studies were studied further. In statistical analysis rankogram was adjusted to rank of each treatment in decreasing IOP. In the ranking, the more positive the value, the better the effect.
According to the results prostaglandin analog-timolol combination was more effective than other combinations, mean 3,60 mmHg (CI 1,47-5,73) followed by brimonidine-timolol combination mean 1,23mmHg (CI -2,83-5,29), timolol-corbonic anhydrase inhibitors mean -1,43 mmHg (CI -3,62-0,77) and brimonidine-carbonic anhydrase inhibitors mean -1,95 mmHg (CI -6,91-3,00) «Li F, Huang W, Zhang X. Efficacy and safety of dif...»1.
| mmHg | 95 % CI | |
|---|---|---|
| Prostaglandin analogue-timolol | 3.60 | 1.47 to 5.73 |
| Brimonidine-timolol | 1.23 | -2,83 to 5,29 |
| Timolol-corbonic anhydrase inhibitors | -1.43 | -3.62 to 0.77 |
| Brimonidine-carbonic anhydrase inhibitors | -1,95 | -6,91 to 3.00 |
Systematic Review 2
The long-term efficacy of the fixed combination of prostaglandin analogues (PGA)/timolol therapy overweighed the PGAs monotherapy in lowering IOP, but in the incidence of hyperemia and eye irritation syndromes, the differences are not statically significant. More RCTs with detailed and authentic data over the assessments of visual functions and morphology of optic nerve heads are hoped to be conducted «Liu AW, Gan LY, Yao X ym. Long-term assessment of ...»2.