Liu Yuanzhi, Zhao Junyi, Zhong Xiaoyan, Wei Qiming, Huang Yilan
Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
College of Pharmacy, Southwest Medical University, Luzhou, China.
Front Pharmacol. 2019 Jun 25;10:679. doi: 10.3389/fphar.2019.00679. eCollection 2019.
Brinzolamide as a carbonic anhydrase inhibitor could be combined with other intraocular pressure (IOP) lowering drugs for glaucoma and ocular hypertension (OHT), but the efficacy was controversial. So, this study was used to assess the efficacy and safety of brinzolamide as add-on to prostaglandin analogues (PGAs) or β-blocker in treating patients with glaucoma or OHT who fail to adequately control IOP. We searched PubMed, Embase, MEDLINE, Cochrane Library, and clinicaltrials.gov from inception to October 4, 2018. Randomized controlled trials of brinzolamide as add-on to PGAs or β-blocker for glaucoma and OHT were included. Meta-analysis was conducted by RevMan 5.3 software. A total of 26 trials including 5,583 patients were analyzed. Brinzolamide produced absolute reductions of IOP as an adjunctive therapy for patients with glaucoma or OHT. Brinzolamide and timolol were not significantly different in lowering IOP as add-on to PGAs (9 am: = 0.07; 12 am: = 0.66; 4 pm: = 0.66). Likewise, brinzolamide was as effective as dorzolamide in depressing IOP (9 am: = 0.59; 12 am: = 0.94; 4 pm: = 0.95). For the mean diurnal IOP at the end of treatment duration, there were no statistical differences in above comparisons ( > 0.05). Compared with brimonidine (b.i.d.), there was a significant reduction of IOP in brinzolamide (b.i.d.) at 9 am ( < 0.0001); however, the difference was cloudy in thrice daily subgroup ( = 0.44); at 12 am, brinzolamide (b.i.d.) was similar to brimonidine (b.i.d.) in IOP-lowering effect ( = 0.23), whereas brimonidine (t.i.d.) led to a greater effect than brinzolamide (t.i.d.) ( = 0.02). At 4 pm, brinzolamide (b.i.d.) was superior IOP-lowering effect compared with brimonidine (b.i.d.) ( = 0.0003); conversely, the effect in brinzolamide (t.i.d.) was lower than brimonidine (t.i.d.) ( < 0.0001). For the mean diurnal IOP, brinzolamide was lower in twice daily subgroup ( < 0.00001); brimonidine was lower in thrice daily subgroup ( < 0.00001). With regard to the safety, brinzolamide and dorzolamide had a higher incidence of taste abnormality; moreover, brinzolamide resulted in more frequent blurred vision; dorzolamide resulted in more frequent ocular discomfort and eye pain. Timolol resulted in more frequent blurred vision and less conjunctival hyperemia. Brimonidine resulted in more frequent ocular hyperemia. As to other adverse events (AEs) (conjunctivitis, eye pruritus, foreign body sensation in eyes, and treatment-related AEs), brinzolamide was similar to other three active comparators. Brinzolamide, as add-on to PGAs or β-blocker, significantly decreased IOP of patients with refractory glaucoma or OHT and the AEs were tolerable.
布林佐胺作为一种碳酸酐酶抑制剂，可与其他降低眼压（IOP）的药物联合用于治疗青光眼和高眼压症（OHT），但其疗效存在争议。因此，本研究旨在评估布林佐胺作为前列腺素类似物（PGAs）或β受体阻滞剂的附加药物，用于治疗眼压未能得到充分控制的青光眼或高眼压症患者的疗效和安全性。我们检索了从数据库建立至2018年10月4日的PubMed、Embase、MEDLINE、Cochrane图书馆和clinicaltrials.gov。纳入了布林佐胺作为PGAs或β受体阻滞剂附加药物治疗青光眼和高眼压症的随机对照试验。使用RevMan 5.3软件进行荟萃分析。共分析了26项试验，包括5583例患者。布林佐胺作为青光眼或高眼压症患者的辅助治疗可使眼压绝对降低。作为PGAs的附加药物，布林佐胺和噻吗洛尔在降低眼压方面无显著差异（上午9点： = 0.07；中午12点： = 0.66；下午4点： = 0.66）。同样，布林佐胺在降低眼压方面与多佐胺效果相当（上午9点： = 0.59；中午12点： = 0.94；下午4点： = 0.95）。在治疗结束时的平均昼夜眼压方面，上述比较无统计学差异（ > 图0.05）。与溴莫尼定（每日两次）相比，布林佐胺（每日两次）在上午9点时眼压显著降低（ < 0.0001）；然而，在每日三次亚组中差异不明显（ = 0.44）；在中午12点，布林佐胺（每日两次）与溴莫尼定（每日两次）降低眼压的效果相似（ = 0.23），而溴莫尼定（每日三次）的效果优于布林佐胺（每日三次）（ = 0.02）。在下午4点，布林佐胺（每日两次）降低眼压的效果优于溴莫尼定（每日两次）（ = 0.0003）；相反，布林佐胺（每日三次）的效果低于溴莫尼定（每日三次）（ < 0.0001）。对于平均昼夜眼压，布林佐胺在每日两次亚组中较低（ < 0.00001）；溴莫尼定在每日三次亚组中较低（ < 0.00001）。在安全性方面，布林佐胺和多佐胺味觉异常的发生率较高；此外，布林佐胺导致视物模糊更频繁；多佐胺导致眼部不适和眼痛更频繁。噻吗洛尔导致视物模糊更频繁且结膜充血较少。溴莫尼定导致眼部充血更频繁。至于其他不良事件（AEs）（结膜炎、眼痒、眼部异物感和与治疗相关的不良事件），布林佐胺与其他三种活性对照药物相似。布林佐胺作为PGAs或β受体阻滞剂的附加药物，可显著降低难治性青光眼或高眼压症患者的眼压，且不良事件可耐受。
