A systematic review of the characteristics of randomised control trials featuring prostaglandins for the treatment of glaucoma^*

ABSTRACT

Aim: To classify the comparative quantity and quality of the RCT evidence of pharmacological treatment for glaucoma.

Method: A systematic review of MEDLINE, EMBASE Cochrane CENTRAL and relevant conference proceedings was conducted up to March 2007. RCTs recruiting adults with primary open angle glaucoma (POAG) and/or ocular hypertension (OH) receiving any topical medication or placebo were included. RCTs containing a prostaglandin treatment arm were specifically considered.

Results: A total of 510 publications were identified. Of these, 181 studies had a prostaglandin treatment arm. The median study duration was 12 weeks (IQR 4–13) and 78% of included trials had a duration of 3 months or less. The four studies over 1 year in duration all included a latanoprost and timolol treatment arm. There was a lack of data on younger populations (median of the mean ages of included patients was 63.4 years [IQR: 61–66 years]). Caucasians constituted 79.6% of the studied population. Evidence by ethnicity as well as by co-morbidity, was scarce. The primary outcome for 92% of studies was IOP reduction; little was reported on other indicators. Most trials reported adverse events, with hyperaemia most commonly reported.

Conclusion: The RCT evidence base for glaucoma treatment is extensive. This systematic review is the first to consider the characteristics of all RCTs containing a prostaglandin arm. The majority of trials are of short duration and focus on IOP as the efficacy outcome. The limitations of this study are that only trials with a prostaglandin treatment arm are included and due to the large number of included trials only top line data were extracted.

Key words: :

• Bimatoprost
• Glaucoma
• Latanoprost
• Prostaglandins
• Randomised controlled trial
• Travoprost

Acknowledgements

Declaration of interest: This review was funded by Pfizer Ltd, manufacturer of latanoprost. C.-W.L. and S.K. are employees of Pfizer Ltd. and were involved in designing the review and in the interpretation of results, as well as the drafting, editing and reviewing of this manuscript.

Notes

* An abstract summarising this work has been presented at the 7th International Symposium on Ocular Pharmacology and Therapeutics (ISOPT), Hungary, 28 February–2 March 2008