Cheng Jin-Wei, Xi Gui-Lin, Wei Rui-Li, Cai Ji-Ping, Li You
Department of Ophthalmology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China.
J Ocul Pharmacol Ther. 2009 Feb;25(1):55-64. doi: 10.1089/jop.2008.0080.
The aim of this study was 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).
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.
Fourteen (14) 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, 0.47-5.78) 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: range, -5.78 to -2.50). The combination of dorzolamide and timolol was less tolerated than latanoprost, with pooled relative risk for withdrawals due to adverse events being 0.34 (range, 0.13-0.84).
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 tolerated than latanoprost.
本研究旨在评估与多佐胺和噻吗洛尔联合用药相比，拉坦前列素治疗眼压升高患者的疗效和耐受性。
通过系统检索Cochrane图书馆、PubMed、EMBASE、中国生物医学数据库，并在互联网上检索会议摘要和制造商数据库，确定相关的随机对照试验。主要疗效指标为眼压降低（IOPR），包括日平均眼压降低和上午10点眼压降低。主要耐受性指标为因不良事件导致的停药和个体不良事件。
荟萃分析纳入了14项研究，共2149例患者。在仅用噻吗洛尔眼压控制不佳的患者中，拉坦前列素降低日平均眼压的效果显著优于多佐胺和噻吗洛尔联合用药，3个月时日平均眼压降低百分比的加权平均差（WMD）为3.12（95%置信区间，0.47 - 5.78）；在未接受过噻吗洛尔基线治疗患者中，拉坦前列素与多佐胺和噻吗洛尔联合用药效果相当。在基线时接受或未接受噻吗洛尔治疗的患者中，多佐胺和噻吗洛尔联合用药在上午10点眼压降低数值上比拉坦前列素更大：仅在基线时接受噻吗洛尔治疗的患者中，1个月时的结果具有统计学意义（WMD -4.14：范围，-5.78至-2.50）。多佐胺和噻吗洛尔联合用药的耐受性低于拉坦前列素，因不良事件导致停药的合并相对风险为0.34（范围，0.13 - 0.84）。
在仅用噻吗洛尔眼压控制不佳的患者中拉坦前列素降低日平均眼压的疗效显著优于多佐胺和噻吗洛尔联合用药；在未接受噻吗洛尔基线治疗患者中，拉坦前列素与多佐胺和噻吗洛尔联合用药效果相当。多佐胺和噻吗洛尔联合用药的耐受性低于拉坦前列素。
