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Luciano Quaranta, Ivano Riva, Andrea Russo, Daniela Garavaglia, Elena Biagioli, Eliana Rulli, Andreas Katsanos, Davide Poli, Stefano Miglior; Prostaglandin Analogues (PGAs) And Timolol Fixed Combination (Fc) Vs. Extemporaneous Combination (Ec) Or Monotherapy (Mt) In The Treatment Of Primary Open-angle Glaucoma (POAG) And Ocular Hypertension (OHT): A Systemtic Review And Meta-analysis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):215.
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PGAs are the first-choice drugs for the treatment of POAG and OHT. They are administered as Mt or as Fc or Ec with Timolol, a topical beta-blocker. Aim of this meta-analysis was to combine the results of the trials comparing the efficacy of Fc of Timolol and PGAs vs. Ec or vs. Mt.
MEDLINE and EMBASE were searched for articles published until May 2010. Randomized, controlled trials, comparing treatment with Timolol and PGAs Fc vs. Ec or vs. Mt in patients with POAG or OHT were considered eligible. Quality of studies was assessed using a modified Delphi list, whose score ranges from -15 to +15. The primary efficacy endpoint was the mean difference (MD) between arms of the diurnal intraocular pressure (IOP) reduction from baseline. The pooled estimates were calculated using random effects.
Out of 855 retrieved articles, 15 were eligible accounting for a total of 22 comparisons: 18 assessing Fc vs. Mt, 4 Fc vs. Ec. The median quality score was 12 (range 5-15). Fc was more effective than both its components in Mt: Fc vs. Mt with Timolol (MD=-2.42, 95%CI -2.99,-1.85); Fc vs. Mt with PGAs (MD=-1.22, 95%CI -1.84,-0.59). When considering the type of PGAs given as Mt, the difference in efficacy between Fc and Latanoprost (MD=-1.21, 95%CI -1.75,-0.66) was smaller than in the comparison between Fc and Travoprost (MD=-2.14, 95%CI -3.05,-1.24). The only trial comparing Fc vs. Mt with Bimatoprost showed no significant difference (MD=-0.20, 95%CI -0.69,0.29). Moreover, the comparison between Fc and Ec showed that Fc is less effective in reducing IOP than Ec (MD=0.76, 95%CI 0.34, 1.17).
The results of this meta-analysis suggest that Fc are more effective than Mt, and Ec seems to have a greater extent of IOP reduction when compared with Fc.
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