Product information and disease description Place of product in therapy Approaches to treatment Current treatment options and standard of care

Prostaglandin analogs

8 evidence topics · 5 sources

AAO Primary Open-Angle Glaucoma Preferred Practice Pattern: prostaglandin analogs as initial medical therapy

“Topical medical therapy is currently the most common initial intervention to lower IOP (see Table 4 for an overview of options available). Prostaglandin analogs are the most frequently prescribed eye drops for lowering IOP in patients with glaucoma because they are most efficacious and well tolerated, and they need to be instilled only once daily.” (opens the source at this quote in a new tab)
“Therefore, prostaglandin analogs are often selected as initial medical therapy unless other considerations, such as contraindications, cost, side effects, intolerance, or patient refusal preclude this.” (opens the source at this quote in a new tab)

AAO Preferred Practice Pattern: prostaglandin analog class profile (bimatoprost, latanoprost, latanoprostene bunod, omidenepag, tafluprost, travoprost)

Field	Quoted record
Mechanism of action	“Increase uveoscleral outflow”
IOP reduction	“25%–33%”
Potential contraindications	“Macular edema”; “History of herpetic keratitis”; “Active uveitis”

European Glaucoma Society guidelines, 6th edition: first-choice medical treatment

“Recommendation: Prostaglandin analogs (PGAs) are the most effective medication, and they are usually recommended as first-choice medical treatment for open-angle glaucoma.” (opens the source at this quote in a new tab)
“Level of evidence: high” (opens the source at this quote in a new tab)
“PGAs have become the first-choice therapy largely on the basis of their efficacy, as well as the practicality of once-daily dosing and of their systemic safety profile. The United Kingdom Glaucoma Treatment Study (UKGTS) has provided high level evidence for the vision-preserving effect of topical latanoprost treatment.” (opens the source at this quote in a new tab)

NICE NG81: generic prostaglandin analog when SLT is declined, unsuitable, or insufficient

“Offer a generic PGA to people with COAG if:” (opens the source at this quote in a new tab)
“they choose not to have 360° SLT or” (opens the source at this quote in a new tab)
“360° SLT is not suitable (for example because they have pigment dispersion syndrome) or” (opens the source at this quote in a new tab)
“they are waiting for an 360° SLT and need an interim treatment or” (opens the source at this quote in a new tab)
“they have previously had 360° SLT but need additional treatment to reduce their IOP sufficiently to prevent the risk of visual impairment.” (opens the source at this quote in a new tab)

Network meta-analysis of first-line topical medications: mean IOP reduction at 3 months

“We included 114 randomized controlled trials with data from 20,275 participants.” (opens the source at this quote in a new tab)
“The mean reductions (95% credible intervals) in IOP in mmHg at 3 months, ordered from the most to least effective drugs were: bimatoprost 5·61 (4·94; 6·29), latanoprost 4·85 (4·24; 5·46), travoprost 4·83 (4·12; 5·54), levobunolol 4·51 (3·85; 5·24), tafluprost 4·37 (2·94; 5·83), timolol 3·7 (3·16; 4·24), brimonidine 3·59 (2·89; 4·29), carteolol 3·44 (2·42; 4·46), levobetaxolol 2·56 (1·52; 3·62), apraclonidine 2·52 (0·94; 4·11), dorzolamide 2·49 (1·85; 3·13), brinzolamide 2·42 (1·62; 3·23), betaxolol 2·24 (1·59; 2·88), and unoprostone 1·91 (1·15; 2·67).” (opens the source at this quote in a new tab)
“Bimatoprost, latanoprost, and travoprost are among the most efficacious drugs, although the within-class differences were small and may not be clinically meaningful.” (opens the source at this quote in a new tab)

UKGTS: latanoprost versus placebo and visual field preservation

“We enrolled 516 individuals between Dec 1, 2006, and March 16, 2010.” (opens the source at this quote in a new tab)
“At 24 months, mean reduction in intraocular pressure was 3·8 mm Hg (4·0) in 231 patients assessed in the latanoprost group and 0·9 mm Hg (3·8) in 230 patients assessed in the placebo group. Visual field preservation was significantly longer in the latanoprost group than in the placebo group: adjusted hazard ratio (HR) 0·44 (95% CI 0·28-0·69; p=0·0003).” (opens the source at this quote in a new tab)

Network meta-analysis: bimatoprost concentrations analyzed and efficacy of bimatoprost 0.01%

“Of the 17 bimatoprost trials included in our network, 15 evaluated bimatoprost 0·03% and two evaluated bimatoprost 0·01%.” (opens the source at this quote in a new tab)
“Bimatoprost 0.01% is no more effective than latanoprost or travoprost in lowering IOP at 3 months.” (opens the source at this quote in a new tab)
“Bimatoprost, when the two concentrations (0·03% and 0·01%) are not differentiated, resulted in a statistically significant lower IOP than any other active drug except tafluprost, although the pair-wise differences in lowering IOP at 3 months among bimatoprost, latanoprost, travoprost, and tafluprost are small and may not be clinically meaningful.” (opens the source at this quote in a new tab)

Limitations of the first-line medication evidence base

“An evidence synthesis such as the network meta-analysis we have done does not overcome the underlying fact that some studies we included were at high or unclear risk of bias, had small sample size, short follow-up time and used IOP, a surrogate outcome to assess treatment effect.” (opens the source at this quote in a new tab)