Home > DARE Reviews > Effects of travoprost in the treatment...

PubMed Health. A service of the National Library of Medicine, National Institutes of Health.

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].

Effects of travoprost in the treatment of open-angle glaucoma or ocular hypertension: a systematic review and meta-analysis

JW Cheng, GL Xi, RL Wei, JP Cai, and Y Li.

Review published: 2009.

CRD summary

This review found that travoprost was as effective as latanoprost in lowering intraocular pressure in patients with open-angle glaucoma or ocular hypertension; both interventions were generally well-tolerated. This was a generally well-conducted review and the authors' conclusions are likely to be reliable.

Authors' objectives

To compare the efficacy and tolerability of travoprost and latanoprost in the treatment of open-angle glaucoma or ocular hypertension.

Searching

MEDLINE, EMBASE, the Cochrane Library and the Chinese Biomedical database were searched without language restrictions. Search dates spanned 1996 to December 2008. Search terms were reported. The Internet was searched using Google and Yahoo, as were the websites of relevant associations and their conference sites. ClinicalTrials.gov and the Chinese Clinical Trials Registry were also searched for ongoing trials. Manufacturers were contacted for further data. References of retrieved articles and reviews were handsearched.

Study selection

Randomised controlled trials (RCTs) that compared the efficacy of travoprost 0.004% and latanoprost 0.005% monotherapy once daily in the treatment of open-angle glaucoma or ocular hypertension (in patients with intraocular pressure greater than 21mmHg after washout period) were eligible for inclusion. Trials of patients with other types of glaucoma, trials with adjuvant intraocular pressure lowering therapy and trials administering the intervention through non-topical routes were excluded. Outcomes eligible for inclusion were diurnal mean intraocular pressure reduction and/or intraocular pressure reduction at 9am and/or 5pm measured more than 24 hours after baseline.

Included trials were of patients with primary open-angle glaucoma, ocular hypertension, exfoliative glaucoma or other open-angle glaucoma. Treatment duration ranged from two weeks to 12 months. The majority of patients in the included trials had primary open-angle glaucoma. The mean age of patients ranged from 51 to 71 years. Trials were conducted in various countries (China, Greece, Italy, Latin America, Romania, Spain, Turkey and the USA).

Two reviewers independently selected the articles and checked by a third reviewer. All reviewers were blinded.

Assessment of study quality

The authors appeared to use a modified version of the Jadad scale to assess the methodological quality of the included trials, including criteria on allocation concealment, blinding, use of intention-to-treat analysis and loss to follow-up, giving a maximum score of 5 points. Trials scoring 2 points or less were judged to be poor quality.

Two reviewers independently conducted the validity assessment.

Data extraction

The mean and standard deviation (SD) intraocular pressure reduction was extracted for each group to calculate mean differences for continuous outcomes. Relative risks (RRs) were calculated for dichotomous outcomes. Where means were not available, these were estimated according to methods described in the Cochrane Handbook for Systematic Reviews of Interventions. The number of patients in each group reporting adverse events was extracted.

Two reviewers independently extracted the data for review with differences resolved by discussion.

Methods of synthesis

For continuous data, weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated on an intention-to-treat basis using a random-effects model and stratified according to length of treatment. For dichotomous data, pooled relative risks (RR) with 95% confidence intervals were calculated. Statistical heterogeneity was assessed using the Χ2 and I2 statistics. Publication bias was assessed through visual inspection of funnel plots.

Results of the review

Seventeen RCTs were included for the review (n=1,491 patients), including four crossover designs (n=156 patients) and 13 parallel group designs (n=1,335 patients). Two trials scored 5 points in the quality assessment, four scored 4 points, seven scored 3 points, three scored 2 points and one scored 1 point. Withdrawal rates ranged from 0 to 39%.

Diurnal mean intraocular pressure reduction: Travoprost significantly reduced diurnal mean intraocular pressure compared to latanoprost at two weeks (WMD 1.47mmHg, 95% CI 0.33 to 2.62; four RCTs, n=505 patients) and two months (WMD 0.71mmHg, 95% CI 0.04 to 1.38; RCTs; n=146 patients), but not at one, three, six or twelve months. When the four RCTs with a quality score of 2 points or less were excluded, there were no significant differences between the groups. There was evidence of significant statistical heterogeneity at two weeks (I2=60.7%) and one month (I2=65.3%).

Mean intraocular pressure reduction at 9am and 5pm: There were no significant differences between travoprost and latanoprost in mean 9am intraocular pressure reduction at any times points (five RCTs). Travoprost significantly reduced the mean 5pm intraocular pressure compared to latanoprost at two weeks (WMD 0.87mmHg, 95% CI 0.40 to 1.33; three RCTs; n=726 patients) but not at one, two, three, six months or twelve months. There was no evidence of significant statistical heterogeneity except for mean 9am intraocular pressure reduction at two months (Q=18.29, p>0.001).

Adverse events: The adverse events reported were generally mild and resolved without treatment. The most common adverse events were hyperaemia (42.2% travoprost and 25.3% latanoprost) and eyelash growth (travoprost 8.0% and latanoprost 5.2%). Travoprost significantly increased the risk of hyperaemia compared to latanoprost (RR 1.72, 95% CI 1.33 to 2.23; nine RCTs; n=1,268 patients). There were no differences between treatments in the risk of any other adverse events. Three patients discontinued travoprost due to conjunctival hyperaemia.

There was no evidence of publication bias

Authors' conclusions

Travoprost was as effective as latanoprost in lowering intraocular pressure in patients with open-angle glaucoma or ocular hypertension. Both interventions were generally well-tolerated.

CRD commentary

The review addressed clear question with well-defined inclusion criteria. Several relevant databases were searched. Attempts were made to identify unpublished data and publication bias was assessed and ruled out. No language restrictions were applied during the search, minimising the risk of language bias. Appropriate steps were taken throughout the review process to minimise the risk of reviewer error and bias.

A validity assessment was performed, but the authors did not investigate the impact of the trial quality on the findings. Appropriate methods were used to combine the trials and statistical heterogeneity was assessed.

This was a generally well-conducted review and the authors' conclusions are likely to be reliable.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated that further RCTs with a duration of more than twelve months are needed to assess the long-term efficacy of travoprost.

Funding

Not stated

Bibliographic details

Cheng JW, Xi GL, Wei RL, Cai JP, Li Y. Effects of travoprost in the treatment of open-angle glaucoma or ocular hypertension: a systematic review and meta-analysis. Current Therapeutic Research 2009; 70(4): 335-350. [PMC free article: PMC3967344] [PubMed: 24683242]

Indexing Status

Subject indexing assigned by CRD

MeSH

Glaucoma, Open-Angle /drug therapy; Humans; Ocular Hypertension /drug therapy; Prostaglandins F, Synthetic

AccessionNumber

12009110011

Database entry date

17/03/2010

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: 24683242

PubMed Health Blog...

read all...

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...