Comparative Effectiveness of First-Line Medications for Primary Open-Angle Glaucoma: A Systematic Review and Network Meta-analysis.
Comparative Effectiveness of First-Line Medications for Primary Open-Angle Glaucoma: A Systematic Review and Network Meta-analysis.
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DOI：
10.1016/j.ophtha.2015.09.005
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发表时间：
2016-01
期刊：
影响因子：
13.7
通讯作者：
Dickersin K
中科院分区：
文献类型：
--
作者：
Li T;Lindsley K;Rouse B;Hong H;Shi Q;Friedman DS;Wormald R;Dickersin K
原发性开角型青光眼(POAG)是一种在世界范围内高度流行的疾病，也是导致不可逆性视力丧失的最常见原因。其目的是通过系统回顾和网络荟萃分析来评估一线药物治疗对POAG或高眼压患者的比较效果，并提供这些治疗的相对排名。POAG的治疗目前完全依靠降低眼压(IOP)。虽然在青光眼的初始治疗中可以考虑局部滴眼、激光和手术，但大多数患者选择开始使用眼药水进行治疗。我们纳入了随机对照试验，将单一有效的局部用药与没有治疗/安慰剂或另一种单一局部用药进行比较。我们搜索了CENTAL、MEDLINE、EMBASE和美国食品和药物管理局的网站。两个人独立评估试验资格，提取数据，并评估偏倚的风险。我们进行了贝叶斯网络荟萃分析。我们纳入了114项随机对照试验，数据来自20,275名参与者。纳入试验的总体偏倚风险喜忧参半。治疗3个月后，平均眼压下降(95%可信区间)由高到低依次为：比马前列酮5·61(4·94；6·29)、拉坦前列素4·85(4·24；5·46)、曲伏前列素4·83(4·12；5·54)、左丁洛尔4·51(3·85；5·24)、他氟前列素4·37(2·94；5·83)、噻吗洛尔3·7(3·16；4·24)、布莫尼定3·59(2·89；4·29)、卡特洛尔3·44(2·42；4·46)、左旋贝洛洛尔2·56(1·52；3·62)、阿普洛定2·52(0·94；4·11)、多唑胺2·49(1·85；3·13)、布林唑胺2·42(1·62；3·23)、倍他洛尔2·24(1·59；2·88)、和非前列腺素1·91(1·15；2·67)。与安慰剂相比，所有有效的一线药物在3个月时都能有效降低眼压。比马前列素、拉坦前列素和曲伏前列素是最有效的药物，尽管组内差异很小，可能没有临床意义。在为特定患者选择药物时，应考虑所有因素，包括不良反应、患者偏好和成本。
Primary open angle glaucoma (POAG) is a highly prevalent condition worldwide and the most common cause of irreversible sight loss. The objective is to assess the comparative effectiveness of first line medical treatments in patients with POAG or ocular hypertension through a systematic review and network meta-analysis, and to provide relative rankings of these treatments. Treatment for POAG currently relies completely on lowering the intraocular pressure (IOP). While topical drops, lasers, and surgeries can be considered in the initial treatment of glaucoma, most patients elect to start treatment with eye drops. We included randomized controlled trials that compared a single active topical medication with no treatment/placebo or another single topical medication. We searched CENTRAL, MEDLINE, EMBASE and the Food and Drug Administration's website. Two individuals independently assessed trial eligibility, abstracted data, and assessed the risk of bias. We performed Bayesian network meta-analyses. We included 114 randomized controlled trials with data from 20,275 participants. The overall risk of bias of the included trials is mixed. The mean reductions (95% credible intervals) in IOP in mmHg at 3 months, ordered from the most to least effective drugs were: bimatoprost 5·61 (4·94; 6·29), latanoprost 4·85 (4·24; 5·46), travoprost 4·83 (4·12; 5·54), levobunolol 4·51 (3·85; 5·24), tafluprost 4·37 (2·94; 5·83), timolol 3·7 (3·16; 4·24), brimonidine 3·59 (2·89; 4·29), carteolol 3·44 (2·42; 4·46), levobetaxolol 2·56 (1·52; 3·62), apraclonidine 2·52 (0·94; 4·11), dorzolamide 2·49 (1·85; 3·13), brinzolamide 2·42 (1·62; 3·23), betaxolol 2·24 (1·59; 2·88), and unoprostone 1·91 (1·15; 2·67). All active first-line drugs are effective compared to placebo in reducing IOP at 3 months. Bimatoprost, latanoprost, and travoprost are among the most efficacious drugs, although the within class differences were small and may not be clinically meaningful. All factors, including adverse effects, patient preferences, and cost should be considered in selecting a drug for a given patient.