Objective To evaluate the efficacy and tolerability of latanoprost compared with the combination of dorzolamide and timolol in the treatment of patients with elevated intraocular pressure (IOP).
Methods Pertinent randomized controlled trials were identified through systematic searches of the Cochrane Library, PubMed, EMBASE, Chinese Biomedicine Database, and internet searches of meeting abstracts and the manufacturers' databases. The main efficacy measures were the IOP reduction (IOPR), including diurnal mean IOPR, and 10:00 IOPR. The main tolerability measure was withdrawal due to adverse events and individual adverse events.
Results Fourteen studies involving 2149 patients were included in the meta-analysis. Latanoprost was significantly more effective in lowering diurnal mean IOP than combined dorzolamide and timolol in patients with IOP insufficiently controlled by timolol alone, with a weighted mean difference (WMD) for the diurnal mean IOPR% of 3.12 (95% confidence interval, 0.47 to 5.78) at 3 months, and latanoprost was as effective as the combination of dorzolamide and timolol in patients without baseline timolol treatment. The combination of dorzolamide and timolol was associated with numerically greater reductions in 10:00 IOP compared with latanoprost in patients with or without timolol treatment at baseline, only the result in patients with baseline timolol treatment at 1 month was statistically significant (WMD -4.14, -5.78 to -2.50). The combination of dorzolamide and timolol was less toleralted than latanoprost, with pooled relative risk (RR) for withdrawals due to adverse events being 0.34 (0.13 to 0.84).
Conclusions Latanoprost was associated with significantly greater efficacy in lowering diurnal mean IOP than combined dorzolamide and timolol in patients with IOP insufficiently controlled by timolol alone, and latanoprost was as effective as combined dorzolamide and timolol in patients without baseline timolol treatment. The combination of dorzolamide and timolol was less toleralted than latanoprost. |
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