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Brinzolamide plus brimonidine for the treatment of glaucoma: an update

INTRODUCTION: Glaucoma is a common sight-threatening condition that is primarily treated by lowering intraocular pressure (IOP). Today the mainstay of treatment is topical ocular hypotensive medications; many patients require more than one agent to achieve target IOP. For such patients, fixed combination formulations have several advantages including simplicity of treatment regimen, adherence to the treatment regimen, efficacy, improved ocular surface comfort and reduced cost. All currently available fixed combinations contain a β-blocker, which is contraindicated in some patients. Hence there is a clinical need for fixed-combination preparations without a β-blocker. This paper reviews the current literature on a new fixed-combination drug containing brinzolamide 1% and brimonidine 0.2% (BBFC).

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

Version: 2014

Efficacy and tolerability of fixed combination of brimonidine 0.2%/timolol 0.5% compared with fixed combination of dorzolamide 2%/timolol 0.5% in the treatment of patients with elevated intraocular pressure: a meta-analysis of randomized controlled trials

OBJECTIVE: To evaluate the efficacy and tolerability of the fixed-combination brimonidine 0.2%/timolol 0.5% (FCBT) compared with the fixed-combination dorzolamide 2%/timolol 0.5% (FCDT) in the treatment of patients with elevated intraocular pressure (IOP).

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

Version: 2013

Meta-analysis of randomised controlled trials comparing latanoprost with brimonidine in the treatment of open-angle glaucoma, ocular hypertension or normal-tension glaucoma

This review compared the effectiveness and adverse effects of latanoprost versus brimonidine for treating open-angle glaucoma, normal-tension glaucoma and ocular hypertension. The authors concluded that latanoprost is more effective in reducing intraocular pressure than brimonidine and that brimonidine causes more fatigue than latanoprost. The review was generally well-conducted and the conclusions are likely to be reliable.

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

Version: 2007

Meta-analysis of randomized controlled trials comparing timolol with brimonidine in the treatment of glaucoma

The authors concluded that timolol and brimonidine were equally effective in lowering intraocular pressure. Brimonidine was associated with a higher rate of allergy. The review was mostly well conducted but, in view of unexplained heterogeneity in the analyses, the authors' conclusions may need to be regarded with some caution.

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

Version: 2008

The efficacy and harm of prostaglandin analogues for IOP reduction in glaucoma patients compared to dorzolamide and brimonidine: a systematic review

This review concluded that latanoprost was superior to dorzolamide but not brimonidine. However, fewer adverse events were found for latanoprost than brimonidine. The authors' conclusions follow from the data presented, but are based on small data sets and as such some caution is advisable.

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

Version: 2008

Medicines given before, during, or after surgery to prevent short spikes of eye pressure after laser surgery for glaucoma

The aim of this Cochrane Review was to find out whether medicines given before, during, or after laser trabeculoplasty (LTP), a surgical method to reduce eye pressure, can prevent increased eye pressure shortly after surgery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Neuroprotection (medicines to protect nerves involved in sight) for treatment of glaucoma in adults

The aim of this Cochrane review was to find out if neuroprotective medications (which aim to protect the nerves and cells in the eye) are effective for treating glaucoma in adults. We searched for all relevant studies to answer this question and found one study.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Treatments for rosacea

Rosacea is a common skin condition causing flushing, redness, red pimples and pustules on the face, and should not be confused with acne. Dilated blood vessels may appear near the surface of the skin (telangiectasia). It can also cause inflammation of the eyes or eyelids, or both (ocular rosacea). Some people can develop a thickening of the skin, especially of the nose (rhinophyma). Although the cause of rosacea remains unclear, a wide variety of treatments are available for this persistent (chronic) and recurring and often distressing disease. These include medications applied directly to the skin (topical), oral medications and light‐based therapies. We wanted to discover how people assessed their treatments: if the treatments changed their quality of life, if they saw changes in their condition and if there were side effects. From the doctors, we wanted to discover whether treatments changed the severity of rosacea, as well as how long it took before symptoms reduced and reappeared.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Glaucoma: Diagnosis and Management of Chronic Open Angle Glaucoma and Ocular Hypertension

This guideline covers adults (18 and older) with a diagnosis of chronic open angle glaucoma or ocular hypertension and those with chronic open angle glaucoma or ocular hypertension associated with pseudoexfoliation or pigment dispersion. In addition, the guideline will cover populations who have a higher prevalence of glaucoma and may have worse clinical outcomes including people with a family history of glaucoma, younger people (<50 years) and people who are of black African or black Caribbean descent. Options for pharmacological, surgical, laser and complimentary or alternative treatments are considered in terms of clinical effectiveness and cost effectiveness.

NICE Clinical Guidelines - National Collaborating Centre for Acute Care (UK).

Version: April 2009
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Medical interventions for primary open angle glaucoma and ocular hypertension

Ocular hypertension (OHT) is a condition with raised intraocular pressure (IOP) without visual field changes or discernible pathology of the optic nerve head. Ocular hypertension with IOP above 21 mmHg untreated is a major risk factor for development of primary open angle glaucoma, which is progressive nerve fibre loss and damage to the optic disc so that the visual field develops characteristic defects. Topical medications are given to reduce the IOP as a way of preventing the onset or progression of damage and associated visual field loss. These medications may have local and systemic side effects that may be severe enough for the treatment to be stopped and include local irritation, drowsiness, shortage of breath and cardiovascular side effects, particularly in the elderly. The results of this review support the current practice of topical medication to lower IOP and clearly demonstrate a visual field protective effect. The review authors identified a total of 26 controlled trials that randomised 4979 people with OHT or open angle glaucoma to receive topical medication or a placebo, another topical medication or no treatment for at least a year. Meta‐analysis of 10 trials testing different topical medications against placebo or untreated controls showed reduced incidence of glaucomatous visual field defects with treatment for people with OHT. The odds ratio (OR) was 0.62 (range 0.5 to 0.8). The class of beta‐blockers (including timolol) had positive but weak evidence for a beneficial effect in protecting against visual field defects (OR 0.7, range 0.5 to 1.0). No single drug showed significant visual field protection in OHT with the evidence available. Medications included beta‐blockers, dorzolamide, brimonidine, pilocarpine and epinephrine. From the reports, the majority of trials were of low methodological quality. Local and systemic side effects leading to treatment being stopped were often poorly reported and did not appear to differ between treatment groups. Drop‐outs due to side effects occurred with similar frequency in people treated with beta‐blocker or placebo and appeared to be less with timolol compared to brimonidine, in three trials.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Efficacy of antiglaucoma fixed combination therapy versus unfixed components in reducing intraocular pressure: a systematic review

This review concluded that fixed combination therapies were equally as safe and effective at lowering intraocular pressure as their individual components administered separately. The conclusions about efficacy are reasonable, but their reliability was dependant upon the appropriateness of the cut-off point used to establish equal effectiveness. The conclusions about equal safety were based on limited data.

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

Version: 2008

Retinal Prostheses in the Medicare Population [Internet]

To determine the safety, efficacy, and evidence for halting disease progression for retinal prosthesis systems (RPSs) and the outcomes that are and could be assessed in future studies of these devices.

Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: September 30, 2016
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Meta-analysis of alpha2-adrenergic agonists versus carbonic anhydrase inhibitors as adjunctive therapy

The review concluded that brimonidine provided greater intraocular lowering efficacy than topical anhydrase inhibitors as adjunctive therapy to beta blockers or prostaglandin analogues in patients with glaucoma or ocular hypertension. The review was unable to rule out the possibility of publication bias and there was substantial heterogeneity in the overall analyses so the authors' conclusions should be considered tentative.

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

Version: 2012

Meta-analysis of medical intervention for normal tension glaucoma

The authors concluded that latanoprost, bimatoprost and timolol were the most effective intraocular pressure lowering agents in patients with normal tension glaucoma. However, the method of combining studies in this review appeared to be inappropriate and therefore the conclusions must be treated with some caution.

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

Version: 2009

Intraocular pressure-lowering effects of commonly used fixed-combination drugs with timolol: a systematic review and meta-analysis

The review concluded that all six commonly used drug combinations containing timolol could effectively lower intra-ocular pressure in patients with primary open-angle glaucoma and ocular hypertension. The authors' conclusions were based on the evidence but the relatively small sample sizes for some drug combinations, uncertain heterogeneity and uncertainty regarding the appropriateness of the synthesis should be considered.

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

Version: 2012

Systematic review of intraocular pressure-lowering effects of adjunctive medications added to latanoprost

This review found that adjunctive medications added to latanoprost (0.005%) decreased intra-ocular pressure in patients with primary open-angle glaucoma or ocular hypertension, especially with timolol (0.5% once daily). The limitations of the data and review methods, particularly the flaws in the analysis, mean that the findings of the review are unlikely to be reliable and should be interpreted with caution.

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

Version: 2009

Intraocular pressure-lowering effects of all commonly used glaucoma drugs: a meta-analysis of randomized clinical trials

The reviewed aimed to determine the effectiveness of the most frequently prescribed intraocular pressure-reducing agents in patients with glaucoma. The authors' conclusion, that there are multiple options for effective monotherapy in this population, should be viewed with some caution because of incomplete reporting of the review process and limitations in the analysis.

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

Version: 2005

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