Abstract
Netarsudil has been approved for lowering elevated intraocular pressure (IOP), showing effectiveness through two distinct mechanisms. It is also effective when used in combination with other therapies to enhance outcomes. This study aims to compare the drug's effectiveness with other treatments, both as a standalone and in combination therapies, while also assessing potential adverse effects to evaluate its overall safety and suitability. We systematically searched PubMed, Cochrane, Web of Science, and Scopus till the 7th of October. Data from eligible studies were extracted and combined using a frequentist network meta-analysis, presented as mean differences (MDs) for continuous outcomes and risk ratios (RRs) along with their 95% confidence intervals (CIs). We used the Cochrane risk-of-bias (ROB) tool to assess the quality of the included RCTs. Netarsudil 0.02%/latanoprost 0.005% fixed-dose combination (FDC) q.d. was the most effective in reducing IOP in one-, two-, and six-week follow-ups in addition to the three-month follow-up. The netarsudil-containing medication was associated with higher adverse events compared to other arms. Netarsudil 0.02%/latanoprost 0.005% FDC q.d. and bimatoprost 0.03%/timolol 0.5% FDC emerged as the most effective therapies for lowering IOP, with each showing significant advantages at different follow-up points. Both FDCs achieved substantial reductions in IOP and a high proportion of patients reaching target IOPs. However, safety profiles indicate that traditional therapies like latanoprost 0.005% and timolol 0.5% may have fewer side effects, including lower incidences of blurred vision, conjunctival hemorrhage, and conjunctival hyperemia.