Meta-analysis of efficacy between Travoprost and Timolol in treating primary open angle glaucoma

Abstract

AIM: To systematically evaluate the changes of hemodynamics, astigmatism and cytokines between travoprost and timolol in the treatment of primary open angle glaucoma(POAG)in Chinese adults.METHODS:Randomized controlled trials(RCTs)and cohort studies comparing the related efficacy of travoprost and timolol for POAG were retrieved from PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure(CNKI), Chinese Biomedical Literature Database(CBM), VIP database and Wanfang database. The search time was from January 1, 2015 to December 31, 2020. The literatures were screened according to the inclusion and exclusion criteria. After quality evaluation by Cochrane tools for RCTs and NOS scores for cohort studies, Review Manager 5.4 software was used for Meta-analyses to generate weighed-mean-difference(WMD)as effect size contrasting the efficacy of travoprost and timolol for the peak systolic velocity(PSV), the end diastolic velocity(EDV)and the resistance index(RI)of the central retinal artery(CRA)and the posterior ciliary artery(PCA), astigmatism, the plasma endothelin-1(ET-1), the serum matrix metalloproteinase(MMP), the tissue inhibitor of metalloproteinase-2(TIMP-2)of the aqueous humor and the serum TIMP-2. RESULTS:Totally 8 RCTs and 4 retrospective cohort studies were included with 1 192 patients.Meta-analysis showed that:compared with timolol group, the travoprost group had greater effect on increasing the PSV(WMD=2.40, 95%CI: 2.12-2.68, P<0.00001; WMD=3.76, 95%CI: 3.30-4.22, P<0.00001)and the EDV(WMD=0.81, 95%CI: 0.70-0.91, P<0.00001; WMD=0.90, 95%CI: 0.72-1.09, P<0.00001)of the CRA and the PCA as well as on decreasing the RI(WMD=-0.07, 95%CI: -0.10 to -0.04, P<0.00001; WMD=-0.07, 95%CI: -0.08 to -0.05, P<0.00001)of the CRA and the PCA; Travoprost was more effective in decreasing astigmatism(WMD=-1.34, 95%CI: -1.62 to -1.06, P<0.00001); Compared with timolol, travoprost could significantly decrease the plasma ET-1(WMD=-5.14, 95%CI: -7.08 to -3.20, P<0.00001)and the serum MMP(WMD=-12.48, 95%CI: -24.27 to -0.69, P=0.04), while no statistically significant differences were found in the TIMP-2 of the aqueous humor(WMD=-1.40, 95%CI: -5.51-2.71, P=0.51)and the serum TIMP-2(WMD=1.69, 95%CI: -30.03-33.41, P=0.92).CONCLUSION:Compared with timolol, travoprost was more effective in improving hemodynamic indexes and decreasing astigmatism in the treatment of POAG.

Keywords

• travoprost
• timolol
• primary open angle glaucoma
• meta-analysis
• hemodynamics