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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Travoprost compared with other prostaglandin analogues or timolol in patients with open-angle glaucoma or ocular hypertension: meta-analysis of randomized controlled trials

N Li, XM Chen, Y Zhou, ML Wei, and X Yao.

Review published: 2006.

Link to full article: [Journal publisher]

CRD summary

This review compared travoprost versus other prostaglandin analogues or timolol as treatments for open-angle glaucoma (OAG) or ocular hypertension (OH). Overall, travoprost 0.004% was more effective than timolol 0.5% for reducing intraocular pressure in patients with OAG or OH, and appears to be equivalent to other prostaglandin analogues. This was a well-conducted review and the authors' conclusions are likely to be reliable.

Authors' objectives

To review travoprost versus other prostaglandin analogues or timolol as treatments for open-angle glaucoma (OAG) or ocular hypertension (OH).

Searching

PubMed, EMBASE, Chinese Biomedical Database and the Cochrane Controlled Trials Register were searched from inception to August 2005 for 'travoprost' or 'travatan'. References were handsearched.

Study selection

The only eligible study design for this review was the randomised clinical trial; all included studies were randomised controlled trials. Populations diagnosed with primary or secondary OAG or OH were eligible; the included studies comprised a mixture of these populations. The specified intervention was travoprost compared with another analogue prostaglandin or timolol. The included studies compared travoprost, timolol, latanaprost, bimatoprost and unoprostone. Relevant outcome measures were defined as the mean intraocular pressure (IOP) during treatment and incidence of side-effects, and were reported as such in the included papers.

Two reviewers carried out the screening independently and then combined their results.

Assessment of study quality

Study validity was assessed using criteria adopted from the Cochrane Eyes and Vision Group: allocation concealment, randomisation, masking, withdrawals and drop-outs, and intention-to-treat analysis.

Two reviewers performed the validity assessment independently, and any differences were resolved by discussion and consensus.

Data extraction

The incidence of reported side-effects and the mean IOP over treatment time were extracted from each study where possible. If mean values were not presented then the IOP measured at the last visit was used. Dichotomous outcomes such as side-effects were calculated as odds ratios, while weighted mean differences (WMDs) were used for continuous outcomes such as IOP.

Methods of synthesis

A quantitative meta-analysis was carried out using fixed-effect and random-effects models to calculate pooled odds ratios and WMDs, as appropriate. Heterogeneity was assessed using χ2; where the p-value was less than 0.1 a fixed-effect model was used, otherwise a random-effecst model was adopted. Publication bias was intended to be assessed using a funnel plot.

Results of the review

This review included 12 studies (n=3,048): 8 double-blind trials (n=2,517) and 4 single-blind trials (n=531).

Of the 12 trials, seven clearly reported their allocation concealment and all detailed withdrawals and drop-outs. Eight reported using intention-to-treat analysis but only five appeared to have used a sample size calculation. Publication bias was to have been assessed using a funnel plot; however, this was not carried out because of the small number of included studies.

The meta-analysis found that travoprost (0.004%) was significantly more effective at lowering IOP than timolol (0.5%); the WMD was -0.81 (95% confidence interval, CI: -1.16, 0.45, p≤0.01). Travoprost (0.004%) was also more effective than unoprostone (0.12%) in lowering IOP. There was no evidence of a significant benefit of travoprost when compared with bimatoprost (0.03%) or latanoprost (0.005%). Comparing two dosages, 0.004% travoprost was significantly better at reducing IOP than 0.0015% travoprost (WMD -0.32, 95% CI: -0.62, -0.02, p=0.04).

Data on side-effects were presented in full. To summarise, the overall incidence of side-effects was lower with timolol than with travoprost. Travoprost 0.004% caused a higher percentage of ocular hyperaemia, iris pigmentation and eyelash changes. Travoprost also caused higher rates of hyperaemia in comparison with latanoprost.

Authors' conclusions

Overall, travoprost 0.004% was more effective than timolol 0.5% for reducing IOP in patients with OAG or OH, and appears to be equivalent to other prostaglandin analogues. The authors therefore advise that side-effects, compliance and cost are taken into consideration when deciding on the appropriate therapy for OAG and OH.

CRD commentary

This review addressed a clearly defined research question with appropriate searches, inclusion criteria, and clear quality assessment and data extraction procedures which are likely to have reduced bias. Language restrictions (only Chinese and English papers were considered) may have introduced some bias and excluded potentially relevant studies. Publication bias could have been assessed using a funnel plot, as the authors initially suggested, and this would have added to a strong review. A quantitative meta-analysis was carried out and incorporated heterogeneity where it was found. Only one analysis remained significantly heterogeneous, but this was not further explored. Overall, this was a well-conducted review and the authors' conclusions are likely to be reliable.

Implications of the review for practice and research

Practice: The authors stated that since travoprost can cause changes in the eyelashes and iris pigmentation, patients receiving treatment for OAG or OH in only one eye should be informed of these risks. Further, since there are no clear differences in benefit among the prostaglandin analogues, side-effects, compliance and cost should be taken into consideration when deciding on the appropriate therapy.

Research: The authors stated that more research is required to explore the IOP effects of travoprost in different races, as studies to date have been predominantly carried out in Caucasian populations.

Funding

Chinese Medical Board Grant on Evidence Based Medicine, USA, grant number 98-680.

Bibliographic details

Li N, Chen X M, Zhou Y, Wei M L, Yao X. Travoprost compared with other prostaglandin analogues or timolol in patients with open-angle glaucoma or ocular hypertension: meta-analysis of randomized controlled trials. Clinical and Experimental Ophthalmology 2006; 34(8): 755-764. [PubMed: 17073898]

Indexing Status

Subject indexing assigned by NLM

MeSH

Aged; Amides /therapeutic use; Antihypertensive Agents /adverse effects /therapeutic use; Cloprostenol /adverse effects /analogs & derivatives /therapeutic use; Dinoprost /analogs & derivatives /therapeutic use; Female; Glaucoma, Open-Angle /drug therapy; Humans; Intraocular Pressure /drug effects; Lipids /therapeutic use; Male; Middle Aged; Ocular Hypertension /drug therapy; Prostaglandins F, Synthetic /adverse effects /therapeutic use; Randomized Controlled Trials as Topic; Timolol /adverse effects /therapeutic use

AccessionNumber

12006007780

Database entry date

01/12/2008

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 17073898

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