Peng Jieting, Huang Wenrui, Duan Junguo
Chengdu University of Traditional Chinese Medicine, Affiliated Eye Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Guangzhou University of Chinese Medicine, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou, China.
Front Med (Lausanne). 2025 Aug 11;12:1642986. doi: 10.3389/fmed.2025.1642986. eCollection 2025.
To evaluate and compare the effectiveness and safety of latanoprost, bimatoprost, travoprost, and tafluprost in lowering intraocular pressure (IOP) in individuals with glaucoma or ocular hypertension.
We searched PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) published up to April 2025 comparing latanoprost, bimatoprost, travoprost, and tafluprost in adults with glaucoma or ocular hypertension. Primary outcomes were IOP reduction and conjunctival hyperemia. We assessed study quality using the Cochrane Risk of Bias 2.0 tool. Evidence certainty was evaluated with the CINeMA framework. A Bayesian network meta-analysis was conducted in RStudio. This review is registered with PROSPERO (CRD420251034803).
25 RCTs published between 2001 and 2024, involving 4,045 participants, were included. All studies compared monotherapy with latanoprost, bimatoprost, travoprost, or tafluprost. Among these, bimatoprost showed the most effective reduction in intraocular pressure compared to latanoprost [mean difference (MD) 0.69; 95%confidence interval (CI) 0.28-1.1; SUCRA 95.6%; moderate confidence]. It also performed significantly better than travoprost (MD 0.64; 0.14-1.09; 39.2%; low confidence). No other comparisons showed statistically significant differences. Overall, the quality of evidence for this outcome ranged from low to moderate. In terms of safety, 16 trials, including 3,119 participants, reported on conjunctival hyperemia. Both bimatoprost [odds ratio (OR) 3.3; 2.5-4.5; 18.4%, high confidence] and travoprost (0.46; 0.33-0.63; 55%, high confidence) were associated with a higher risk of hyperemia compared to latanoprost. Bimatoprost also posed a significantly greater risk than travoprost (1.51; 1.06-2.16, high confidence).
Bimatoprost provided the greatest IOP reduction but carried a higher risk of conjunctival hyperemia. Latanoprost and tafluprost offered balanced efficacy with better tolerability, making them suitable for patients with mild disease.
评估和比较拉坦前列素、比马前列素、曲伏前列素和他氟前列素在降低青光眼或高眼压症患者眼压方面的有效性和安全性。
我们检索了PubMed、Embase、Web of Science和Cochrane图书馆，以查找截至2025年4月发表的比较拉坦前列素、比马前列素、曲伏前列素和他氟前列素治疗成人青光眼或高眼压症的随机对照试验（RCT）。主要结局为眼压降低和结膜充血。我们使用Cochrane偏倚风险2.0工具评估研究质量。采用CINeMA框架评估证据确定性。在RStudio中进行贝叶斯网络meta分析。本综述已在PROSPERO（CRD420251034803）注册。
纳入了2001年至2024年间发表的25项RCT，涉及4045名参与者。所有研究均比较了拉坦前列素、比马前列素、曲伏前列素或他氟前列素的单药治疗。其中，与拉坦前列素相比，比马前列素降低眼压的效果最为显著[平均差（MD）0.69；95%置信区间（CI）0.28 - 1.1；累积排序曲线下面积（SUCRA）95.6%；中等置信度]。其效果也显著优于曲伏前列素（MD 0.64；0.14 - 1.09；39.2%；低置信度）。其他比较均未显示出统计学显著差异。总体而言，该结局的证据质量从中等到低不等。在安全性方面，16项试验（包括3119名参与者）报告了结膜充血情况。与拉坦前列素相比，比马前列素[优势比（OR）3.3；2.5 - 4.5；18.4%，高置信度]和曲伏前列素（0.46；0.33 - 0.63；55%，高置信度）发生充血的风险更高。比马前列素的风险也显著高于曲伏前列素（1.51；1.06 - 2.16，高置信度）。
比马前列素降低眼压的效果最佳，但结膜充血风险较高。拉坦前列素和他氟前列素疗效均衡，耐受性较好，适合轻症患者。
