Abstract
BACKGROUND: A 2005 meta-analysis suggests that lowering intraocular pressure (IOP) in patients with ocular hypertension (OHT) or open-angle glaucoma (OAG) is beneficial in reducing the risk for visual field loss in the long term. OBJECTIVE: The aim of this meta-analysis was to compare the efficacy and toler-ability of travoprost and latanoprost in patients with OAG or OHT. METHODS: Pertinent studies published from 1996 to 2008 were identified using systematic searches of major literature databases, including the Cochrane Library, MEDLINE, EMBASE, and the Chinese Biomedicine Database. Internet searches of major search engines, professional associations' Web sites, and manufacturers' databases were also performed. Randomized controlled trials (RCTs) comparing the effects of travoprost 0.004% and latanoprost 0.005% in patients with OAG or OHT were selected. The primary efficacy measure was the weighted mean difference (WMD) in the IOP reduction (IOPR). The primary tolerability measure was the relative risk (RR) for adverse events. The pooled effects were calculated using the random-effects model. RESULTS: Seventeen studies (1491 patients) were included in the meta-analysis, 4 of which were of poor quality based on Jadad scoring. Travoprost was associated with significantly greater diurnal mean IOPRs compared with latanoprost at 2 weeks and 2 months (WMDs [95% CI] mm Hg: 2 weeks, 1.47 [0.33 to 2.62]; 2 months, 0.71 [0.04 to 1.38]); these values were not significant at 1 (0.81 [-0.78 to 2.40]), 3 (0.01 [-0.50 to 0.52]), and 6 months (0.27 [-0.40 to 0.95]). When the 4 studies of low quality were excluded, no significant treatment differences in diurnal IOPR were found. IOPR measured at 5 pm was significantly greater with travoprost compared with latanoprost at 2 weeks (WMD [95% CI], 0.87 mm Hg [0.40 to 1.33]); these values were not significant at 1 (WMD [95% CI], 0.60 mm Hg [0.00 to 1.20], 2 (0.65 [-0.69 to 1.99]), 3 (0.04 [-0.51 to 0.59]), 6 (0.00 [-0.68 to 0.68]), and 12 months (0.30 [-0.36 to 0.96]). Travoprost was associated with a significantly greater frequency of hyperemia than was latanoprost (RR = 1.72 [95% CI, 1.33 to 2.23]). Rates of serious ocular adverse events did not differ significantly between travoprost and latanoprost (cystoid macular edema: RR = 0.22 [95% CI, 0.03 to 1.76]; cataract: RR = 2.29 [95% CI, 0.90 to 5.83]). CONCLUSIONS: The findings from the present meta-analysis of these 17 RCTs suggest that there were no significant differences between travoprost and latanoprost in IOPR in these patients with OHT or OAG. Both agents were generally well tolerated.