Analytic review of bimatoprost,latanoprost and travoprost in primary open angle glaucoma

ABSTRACT

Objective: The objective of this review was to evaluate different measures of efficacy of the intraocular pressure (IOP) lowering lipid class agents bimatoprost, latanoprost and travoprost in the treatment of primary open angle glaucoma. Study arms of timolol in trials including the above mentioned lipid class drugs were also included.

Methods: MEDLINE and EMBASE were searched for randomized clinical trials including one or more of the lipid class drugs bimatoprost, latanoprost and travoprost. The study results were pooled, and the simple, weighted IOP-lowering efficacy was compared among the lipid class drugs and timolol, where data were available. Efficacy parameters were reviewed, including mean reduction of IOP and percentage of patients achieving different levels of IOP.

Results: 161 articles were identified of which 42 were included in the analysis. A total of 9295 patients participated in the included trials. Based on all studies, timolol on average had a weighted mean IOP reduction of 22.2%, while latanoprost, travoprost and bimatoprost had a weighted mean IOP reduction of 26.7%, 28.7% and 30.3%, respectively. Analysis of target achievement to various IOP levels shows that bimatoprost seems more efficacious than latanoprost. The direct comparisons (head-to-head studies) also show that bimatoprost is the most efficacious treatment, however it is not conclusive whether latanoprost or travoprost is better in reducing IOP.

Conclusions: This review shows that bimatoprost seems to be the most efficacious treatment in lowering IOP. Head-to-head studies confirm this.     

拉坦前列素、噻吗洛尔和曲伏前列素治疗原发性开角型青光眼的疗效观察

目的比较拉坦前列素、噻吗洛尔和曲伏前列素治疗原发性开角型青光眼的疗效。方法 360例原发性开角型青光眼患者随机分为A、B、C组,每组120例。A组采用马来酸噻吗洛尔滴眼液治疗,每天8∶00、20∶00各1次,每次每眼1滴。B组采用拉坦前列素滴眼液治疗,每天20∶00每眼1滴。C组采用曲伏前列素滴眼液治疗,每天20∶00每眼1滴,3组均治疗12个月。比较3组患者眼压改善情况、视野缺损情况、基础泪液分泌试验(Schirmer test,ST)及泪膜破裂时间(break up time,BUT)实验结果以及不良反应。结果 3组患者随治疗时间的延长,眼压均显著下降(F_时间=37.68,P<0.05)。不同组别患者眼压水平存在显著差异(F_组间=13.58,P<0.05),不同组别患者眼压下降幅度存在显著差异(F_{时间×组间}=8.54,P<0.05)。组间两两比较结果显示,B组和C组治疗1个月、3个月、6个月和12个月时眼压均显著低于A组(P<0.05)。B组和C组患者视野缺损评分均显著降低(t=8.37、4....     

The cost-effectiveness of bimatoprost,latanoprost and timolol in treatment of primary open angle glaucoma in five European countries

ABSTRACT

Objective: The objective of this cost-effectiveness analysis is to evaluate cost-effectiveness ratios of the intraocular pressure (IOP)-lowering agents bimatoprost, latanoprost and timolol in five major European countries: France, Germany, Italy, Spain and the UK.

Methods: The cost-effectiveness analysis is based on achievement of IOP targets between 13 and 18?mm Hg. Thus, the cost-effectiveness ratios express the costs of having one patient successfully achieving IOP target. The perspective of the analysis is that of the health care sector payer, including costs of medicine and costs of ophthalmologist visits. The time frame is first year of glaucoma treatment. Four treatment strategies are analysed: Timolol as first line with add-on latanoprost or bimatoprost if IOP targets are not met, and latanoprost and bimatoprost as first line with add-on timolol.

Results: In the UK, Spain, Italy and Germany the timolol first with add-on of bimatoprost is the least expensive treatment. This strategy dominates both strategies involving latanoprost (as add-on to timolol or as first line) in these four countries. The incremental cost-effectiveness ratio of bimatoprost first-line therapy versus timolol with add-on bimatoprost varies from each country and target (from £305 to €43 720 per patient). In France the timolol first line and latanoprost add-on is not dominated and is the cheapest alternative. The incremental cost-effectiveness ratio of timolol with add-on bimatoprost versus add-on latanoprost lies between £71 and €355 per patient depending on target (18 and 13?mm Hg, respectively).

Conclusion: First-line treatment of latanoprost is dominated in all countries. In four out of five countries the timolol first-line therapy with add-on latanoprost is also dominated. Based on this pharmacoeconomic analysis, the most costeffective strategy seems to be timolol first line with add-on bimatoprost if target is not met after 3 months.     

The cost-effectiveness of bimatoprost, latanoprost and timolol in treatment of primary open angle glaucoma in five European countries

OBJECTIVE: The objective of this cost-effectiveness analysis is to evaluate cost-effectiveness ratios of the intraocular pressure (IOP)-lowering agents bimatoprost, latanoprost and timolol in five major European countries: France, Germany, Italy, Spain and the UK. METHODS: The cost-effectiveness analysis is based on achievement of IOP targets between 13 and 18 mm Hg. Thus, the cost-effectiveness ratios express the costs of having one patient successfully achieving IOP target. The perspective of the analysis is that of the health care sector payer, including costs of medicine and costs of ophthalmologist visits. The time frame is first year of glaucoma treatment. Four treatment strategies are analysed: Timolol as first line with add-on latanoprost or bimatoprost if IOP targets are not met, and latanoprost and bimatoprost as first line with add-on timolol. RESULTS: In the UK, Spain, Italy and Germany the timolol first with add-on of bimatoprost is the least expensive treatment. This strategy dominates both strategies involving latanoprost (as add-on to timolol or as first line) in these four countries. The incremental cost-effectiveness ratio of bimatoprost first-line therapy versus timolol with add-on bimatoprost varies from each country and target (from 305 pounds sterlings to 43,720 euros per patient). In France the timolol first line and latanoprost add-on is not dominated and is the cheapest alternative. The incremental cost-effectiveness ratio of timolol with add-on bimatoprost versus add-on latanoprost lies between 71 euros and 355 euros per patient depending on target (18 and 13 mm Hg, respectively). CONCLUSION: First-line treatment of latanoprost is dominated in all countries. In four out of five countries the timolol first-line therapy with add-on latanoprost is also dominated. Based on this pharmacoeconomic analysis, the most cost-effective strategy seems to be timolol first line with add-on bimatoprost if target is not met after 3 months.     

Comments on The cost-effectiveness of bimatoprost,latanoprost and timolol in treatment of primary open angle glaucoma in five European countries

Abstract

Objective:

The dopamine agonist rotigotine has shown efficacy and safety for the treatment of early and advanced Parkinson’s disease (PD) in controlled clinical trials. This observational study evaluated rotigotine administration in combination with other antiparkinsonian medication in routine clinical practice.     

拉坦前列素及噻吗心安治疗开角型青光眼的疗效观察及安全性评估

目的 研究拉坦前列素及噻吗心安治疗开角型青光眼的疗效及安全性.方法 将120例开角型青光眼患者纳入研究对象,随机分为给予拉坦前列素联合噻吗心安治疗的观察组和单独给予噻吗心安治疗的对照组,检测视野缺损情况、视网膜神经纤维层厚度并观察不良反应例数.结果 （1）观察组患者的上方视野（4.9±0.8） dB、下方视野（5.1±0.9）dB、颞侧视野（7.2±1.3）dB、鼻侧视野缺损（6.9± 1.1） dB均明显低于对照组（P＜0.05）;（2）观察组患者的上方视野（92.3±13.2）μm、下方视野（90.8± 12.1） μm、颞侧视野（74.2±10.3）μm、鼻侧视野RNFL厚度（70.8±12.3）μm均明显高于对照组（P＜0.05）;（3）两组患者发生不良反应例数比较差异无统计学意义（P＞ 0.05）.结论 拉坦前列素及噻吗心安治疗开角型青光眼有助于改善视野缺损和视网膜神经纤维层厚度,且保证相当的安全性,具有积极的临床价值.     

Comparing bimatoprost and travoprost in black Americans

ABSTRACT

Objective: To compare the intraocular pressurelowering efficacy and safety of topical bimatoprost 0.03% with that of travoprost 0.004% for the reatment of black patients with open-angle glaucoma (OAG) and ocular hypertension (OHT).

Research design and methods: Multicenter, prospective, randomized, investigator-masked trial of 94 black patients previously diagnosed with OAG or OHT. All patients completed washout of ocular hypotensive medications before study participation. Patients were assigned to either once-daily bimatoprost 0.03% or once-daily travoprost 0.004% for 3 months.

Main outcome measures: The primary outcome measures were mean intraocular pressure (IOP), mean change from baseline IOP, and percentage of patients who reached a target IOP reduction. Secondary measures included ophthalmologic examination and adverse events.

Results: Both bimatoprost and travoprost significantly lowered IOP at all study visits (?p < 0.001). Bimatoprost provided mean IOP reductions from baseline that ranged from 6.8?mmHg to 7.8?mmHg (27% to 31%). Travoprost provided mean IOP reductions from baseline that ranged from 6.2?mmHg to 6.9?mmHg (25% to 28%). By month 3, 85% of participants in the bimatoprost group had a mean IOP reduction of at least 20%, compared with 68% of those in the travoprost group. Furthermore, 31.9% of those in the bimatoprost group had a mean IOP reduction of more than 40% at month 3 compared with 20.9% of those in the travoprost group. There were no significant differences in biomicroscopy, ophthalmoscopy, or visual acuity. Ocular redness was the most commonly reported adverse event in both treatment groups. No serious adverse events were reported.

Conclusions: Bimatoprost and travoprost each effectively lowered IOP in this population of black patients. More patients achieved clinically relevant IOP reductions with bimatoprost.     

毛果芸香碱联合拉坦前列素治疗原发性急性闭角型青光眼的疗效观察

目的探讨毛果芸香碱联合拉坦前列素治疗原发性急性闭角型青光眼的疗效及安全性。方法随机选取2014年5月—2015年1月海南医学院附属医院眼科收治的原发性急性闭角型青光眼患者92例,随机分为对照组和治疗组,每组各46例。对照组给予拉坦前列素滴眼液,1滴/次,1次/d。治疗组在对照组的基础上给药5 min后滴加硝酸毛果芸香碱滴眼液,2~3滴/次,2~4次/d。两组均连续治疗6个月。观察两组的临床疗效,同时比较两组患者治疗前后的视力、瞳孔直径、眼压、血流动力学指标舒张末期血流速度(EDV)、收缩期峰值血流速度(PSV)、血管阻力指数(RI)及不良反应。结果治疗后,对照组和治疗组的总有效率分别为82.61%、95.65%,两组比较差异有统计学意义(P0.05)。治疗1、3、6个月,两组患者的患眼视力、瞳孔直径均较同组治疗前显著改善,同组治疗前后差异具有统计学意义(P0.05);且治疗后,治疗组患者的视力、瞳孔直径改善程度明显优于同期对照组,两组比较差异具有统计学意义(P0.05)。对照组治疗3、6个月,治疗组治疗1、3、6个月的眼压与同组治疗前相比均有显著下降,且治疗组患者眼压下降情况明显优于同期对照组(P0.05);治疗1、3、6个月,治疗组患者的EDV、PSV均明显高于对照组,而RI则明显低于对照组,同组治疗前后差异有统计学意义(P0.05);且治疗组的改善程度优于对照组,两组比较差异有统计学意义(P0.05)。对照组和治疗组的不良反应发生率分别为10.87%、0.00%,两组比较差异有统计学意义(P0.05)。结论毛果芸香碱联合拉坦前列素治疗原发性急性闭角型青光眼疗效显著,可明显改善视力,有效提高视野,降低眼压,安全性高,具有一定的临床推广应用价值。     

原发性开角型青光眼药物治疗的临床观察及护理干预

目的：研究和分析原发性开角型青光眼患者进行药物治疗时的临床观察要点及有效的护理干预措施。方法：收集原发性开角型青光眼患者共85例（162只眼）,随机分为观察组与对照组,各81只眼,对照组患者使用曲伏前列素进行治疗,观察组患者在此基础上接受噻吗洛尔、布林佐胺的联合治疗,并随机抽取两组共45名患者进行护理干预,将两组患者的临床效果进行观察和对比。结果：观察组患者治疗半年后的眼压达标率明显高于对照组,观察组患者治疗1年后的眼压达标率显著高于对照组患者,观察组患者实施护理干预半年和1年后的眼压达标率均明显高于对照组,（P均<0.05）。结论：在原发性开角型青光眼患者的治疗过程中,使用曲伏前列素、噻吗洛尔和布林佐胺的联合治疗,能够有效提高治疗的效果,而患者在接受了护理干预之后,药物治疗的效果得到了有效提高,值得推广应用。     

开角型青光眼图形视网膜电流图与定量静态视野联合检测研究

观察原发性开角型青光眼（ＰＯＡＧ）眼压、视野与图形视网膜电流图（ＰＥＲＧ）ｑ波幅值之间的关系。通过改变空间频率（１２０′、６０′、３０′）选择青光眼电生理学诊断最佳刺激参数。方法对２４例（３０只眼）原发性开角型青光眼病人进行眼压、定量静态视野及ＰＥＲＧ检测。分析眼压、定量静态视野与ＰＥＲＧｑ波幅值关系,结果眼压与ＰＥＲＧｑ波幅值呈负相关,定量静态视野缺陷损程度量静态视野与ＰＥＲＧｑ波幅值关系。结果     

Beta 2-adrenergic receptor polymorphism and susceptibility to primary congenital and primary open angle glaucoma

Objective It has been shown that arginine to glycine (Arg16Gly), glutamine to glutamic acid (Gln27Glu) and threonine to isoleucine (Thr164Ile) exchanges in codons 16, 27 and 164, respectively, of the beta 2-adrenergic receptor (B2AR) gene significantly alter receptor function. As B2ARs are located on the afferent blood vessels supplying the ciliary body and trabecular meshwork cells, which control aqueous humour dynamics, polymorphisms of B2AR may be involved in the pathophysiology of certain eye diseases, such as glaucoma. Therefore, the aim of the present study was to investigate the distribution of B2AR polymorphisms in patients with primary congenital and primary open angle glaucoma.Methods A group of 30 patients with primary congenital glaucoma, 105 with primary open angle glaucoma and 92 control patients were analysed for the Arg16Gly, Gln27Glu, and Thr164IIe polymorphisms of the B2AR by polymerase chain reaction–restriction fragment length polymorphism.Results The allelic frequencies of Gly16, Glu27 and IIe164 variant alleles were 66.7, 38.3 and 3.3% in patients with congenital glaucoma, 59.5, 31.0 and 1.0% with glaucoma, and 54.9, 26.6 and 0.5% in controls, respectively. Although statistically non-significant, the frequencies of variant alleles were slightly higher in both groups of the glaucoma patients.Conclusions These results suggest no evidence of an association between the Arg16Gly, Glu27Gln and Thr164Ile polymorphisms of the B2AR gene and risk of developing primary open angle glaucoma or primary congenital glaucoma. However, further studies are needed to understand the role of B2AR polymorphisms in patients with eye disease.     

曲伏前列素治疗原发性开角型青光眼效果观察

目的 探讨曲伏前列素治疗原发性开角型青光眼(Primary open-angle glaucoma,POAG)的效果.方法 选择本院2020年5月至2021年6月收治的POAG患者60例,随机分为对照组和观察组各30例.对照组使用马来酸噻吗洛尔治疗,观察组使用曲伏前列素治疗.两组均连续治疗1个月.比较两组患者治疗前后视...     

Ex-PRESS青光眼引流钉植入对原发性开角型青光眼患者眼压的影响

目的 分析Ex-PRESS青光眼引流钉植入对原发性开角型青光眼患者眼压的影响.方法 选取2014年2月至2015年10月本院收治的70例(98眼)原发性开角型青光眼患者,将所有患者随机分为两组,各35例(49眼).对照组采用传统小梁切除术,观察组则采用Ex-PRESS青光眼引流钉植入术,对比两组手术成功率、手术前后眼压变化及术后并发症发生率.结果 观察组患者手术成功率为83.67％,明显高于对照组的65.31％,差异有统计学意义(P＜0.05);术前两组眼压变化比较差异无统计学意义(P＞0.05),术后1周、1个月、3个月,对照组患者眼压值均高于观察组,差异均有统计学意义(均P＜ 0.05);观察组术后并发症发生率为8.16％,低于对照组的22.45％,差异有统计学意义(P＜0.05).结论 Ex-PRESS青光眼引流钉植入可有效控制原发性开角型青光眼患者的眼压,手术成功率及安全性均较高,并发症少,在临床应用中值得推广.     

Topical bimatoprost: a review of its use in open-angle glaucoma and ocular hypertension

Bimatoprost, a synthetic prostamide analogue, is a new ocular hypotensive agent indicated for the second-line treatment of open-angle glaucoma and ocular hypertension. The drug is formulated as a 0.03% ophthalmic solution. Bimatoprost lowers intraocular pressure (IOP) by increasing aqueous humour outflow. When applied topically once daily in patients with ocular hypertension or glaucoma, bimatoprost 0.03% significantly reduced IOP. Mean IOP was reduced by approximately 7.5 to 9.2mm Hg 12 hours after drug administration in randomised clinical trials. The reduction in IOP was maintained throughout the 24-hour dosage interval. Once-daily treatment with bimatoprost 0.03% was found to be significantly more effective than timolol 0.5% (administered twice daily as an ophthalmic solution or once daily as a gel-forming solution) in randomised comparative trials in patients with ocular hypertension and glaucoma. Furthermore, after 1 to 6 months' treatment, the percentage of patients reaching a target IOP of < or =17mm Hg was significantly greater in the bimatoprost-treated groups than in those receiving timolol. Bimatoprost 0.03% ophthalmic solution was found to be at least as effective as topical latanoprost 0.005% administered once daily in two clinical trials. Reductions in IOP 16 and 20 hours postdose were greater in patients treated with bimatoprost, indicating superior control of IOP at timepoints throughout the dosage interval. In patients refractory to beta-blocker therapy, treatment with bimatoprost 0.03% produced greater reductions in diurnal IOP measurements than combination therapy with topical dorzolamide 2%/timolol 0.5%; approximately twice as many bimatoprost 0.03% recipients achieved an IOP of < or =16mm Hg. The most commonly reported adverse effect during clinical trials of once-daily bimatoprost 0.03% was conjunctival hyperaemia which occurred in 42 to 46% of patients treated. However, most cases were mild and only 1 to 4% of patients withdrew from treatment as a result. Overall withdrawal rates as a result of adverse events during clinical trials ranged from 2.6 to 7%. Bimatoprost has been reported to cause changes in the pigmentation of the periorbital skin, eyelashes and iris, and increase eyelash growth. The long-term consequences of these effects are unknown. Cardiopulmonary adverse effects, which have been associated with the use of beta-blockers such as timolol, were not reported in clinical trials of bimatoprost. Thus, in clinical trials of up to 1-year duration, bimatoprost 0.03% has been found to be effective in significantly lowering IOP and is generally well tolerated. It provides an alternative treatment option for patients in whom beta-blockers are contraindicated. Furthermore, bimatoprost provides an effective second-line treatment option in patients who do not achieve target IOP with other topical ocular hypotensive agents, or who experience unacceptable adverse effects. Wider clinical use of this drug will establish the place of bimatoprost in the treatment of open-angle glaucoma and ocular hypertension.     

尼莫地平联合曲伏前列素滴眼液治疗原发性开角型青光眼的疗效观察

目的探讨尼莫地平联合曲伏前列素滴眼液治疗原发性开角型青光眼的临床效果。方法选取2015年12月—2017年12月洛阳博爱眼科医院收治的原发性开角型青光眼患者80例,随机分成对照组(40例)和治疗组(40例)。对照组患者睡前滴入曲伏前列素滴眼液,1滴/次,1次/d。治疗组在对照组基础上口服尼莫地平片,1片/次,3次/d。两组均连续治疗12周。观察两组患者临床疗效,同时比较治疗前后两组患者24 h峰值眼压、视功能相关的生存质量量表-25(NEI VFQ-25)总分、视盘参数和视野平均缺损(MD)及视盘筛板血流参数。结果治疗后,对照组和治疗组临床有效率分别为75.0%和92.5%,两组比较差异具有统计学意义(P0.05)。治疗后,两组24 h峰值眼压显著下降(P0.05),NEI VFQ-25总分显著升高(P0.05),且治疗组24 h峰值眼压和NEI VFQ-25总分明显好于对照组(P0.05)。治疗后,两组垂直杯盘比(C/D)、平均C/D和视野MD值均显著降低(P0.05),盘沿面积(RA)值显著升高(P0.05),且治疗组视盘参数和视野MD明显好于对照组(P0.05)。治疗后,两组各视盘筛板血流速度、血流量和红细胞移动速率值均明显升高(P0.05),且治疗组视盘筛板血流参数明显高于对照组(P0.05)。结论尼莫地平联合曲伏前列素滴眼液治疗原发性开角型青光眼能明显控制患者眼压,改善筛板区血流状态,延缓病情进展,提高生活质量。