Cai Ziyan, Cao Mengdan, Liu Ke, Duan Xuanchu
Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
Department of Ophthalmology, Changsha Aier Eye Hospital, Changsha, Hunan, China.
J Ophthalmol. 2021 May 25;2021:5586719. doi: 10.1155/2021/5586719. eCollection 2021.
Within the clinical setting, some patients have been identified as lacking in response to PGAs. This meta-analysis study aimed to evaluate the responsiveness of latanoprost, travoprost, bimatoprost, and tafluprost in OAG/OHT patients, latanoprost nonresponders (LNRs), and the IOP-reducing efficacy and safety.
A literature search was conducted on PubMed, Embase, and the Cochrane Controlled Trials Register. The primary clinical endpoint was the number of responders at the end of the study. The secondary clinical endpoint was the IOP reduction at the endpoint from baseline. Safety evaluation included five common adverse events: conjunctival hyperemia, hypertrichosis, ocular burning, ocular itching, and foreign-body sensation.
Eleven articles containing ten RCTs were included in this meta-analysis study. The results highlighted that, in the OAG/OHT population, there was no statistically significant difference in the responsiveness of the four PGAs. Bimatoprost had a better IOP-reducing efficacy than latanoprost. There was no significant difference in the IOP-reducing efficacy of travoprost, latanoprost, and tafluprost. In LNRs, the responsiveness of bimatoprost, travoprost, and latanoprost did not show statistical differences. Bimatoprost reduced IOP with a greater extent than latanoprost and travoprost in LNRs, while there was no significant difference in the IOP-reducing efficacy of travoprost and latanoprost. No serious adverse events occurred with the treatment of the four PGAs. The prevalence of conjunctival hyperemia due to bimatoprost or tafluprost was significantly higher than that of latanoprost. Other adverse events had no significant difference between the four drugs.
The existing studies cannot prove that latanoprost, travoprost, bimatoprost, and tafluprost have different responsiveness in OAG/OHT patients. Switching to bimatoprost or travoprost cannot achieve a significant improvement in responsiveness in LNRs. Bimatoprost has a better IOP-reducing efficacy than latanoprost and travoprost. No serious adverse events occurred during treatment with any medication we studied.
在临床环境中,已识别出一些患者对前列腺素类似物(PGAs)无反应。本荟萃分析研究旨在评估拉坦前列素、曲伏前列素、比马前列素和他氟前列素在开角型青光眼/高眼压症(OAG/OHT)患者、拉坦前列素无反应者(LNRs)中的反应性,以及眼压降低效果和安全性。
在PubMed、Embase和Cochrane对照试验注册库中进行文献检索。主要临床终点是研究结束时的反应者数量。次要临床终点是终点时相对于基线的眼压降低情况。安全性评估包括五种常见不良事件:结膜充血、多毛症、眼部烧灼感、眼部瘙痒和异物感。
本荟萃分析研究纳入了11篇包含10项随机对照试验(RCT)的文章。结果表明,在OAG/OHT人群中,四种PGAs的反应性无统计学显著差异。比马前列素的眼压降低效果优于拉坦前列素。曲伏前列素、拉坦前列素和他氟前列素的眼压降低效果无显著差异。在LNRs中,比马前列素、曲伏前列素和拉坦前列素的反应性无统计学差异。在LNRs中,比马前列素降低眼压的幅度大于拉坦前列素和曲伏前列素,而曲伏前列素和拉坦前列素的眼压降低效果无显著差异。使用四种PGAs治疗未发生严重不良事件。比马前列素或他氟前列素所致结膜充血的发生率显著高于拉坦前列素。四种药物之间的其他不良事件无显著差异。
现有研究无法证明拉坦前列素、曲伏前列素、比马前列素和他氟前列素在OAG/OHT患者中有不同的反应性。换用比马前列素或曲伏前列素无法显著改善LNRs的反应性。比马前列素的眼压降低效果优于拉坦前列素和曲伏前列素。我们研究的任何药物治疗期间均未发生严重不良事件。