It is not clear how many studies or participants were included in the review; seven RCTs (n=1,178) were included in the meta-analyses. Two RCTs were considered to be of high quality (Jadad score =5), five RCTs received a Jadad score of 2. Two studies clearly reported use of ITT analysis. Where reported, four studies were industry funded.
Reduction in IOP at three months post-treatment
No statistically significant difference in mean IOP was found between those receiving latanoprost and those receiving brimonidine (WMD -1.04, 95% CI: -3.01, 0.93) (3 RCTs, n=471). Evidence of significant statistical heterogeneity was found. The inclusion of only higher quality studies did not change this result significantly.
A statistically significant mean reduction was found in favour of latanoprost compared with dorzolamide (WMD -2.64, 95% CI: -3.25, -2.04, p<0.00001) (3 RCTs, n=328). There was no evidence of significant statistical heterogeneity. All studies were of low study quality.
Adverse events
The relative risk of ocular AEs (excluding hyperaemia) was significantly lower in those receiving latanoprost compared with brimonidine (RR 0.66, 95% CI: 0.52, 0.83, p<0.0005) (3 RCTs, n=803). NNH was 9 (95% CI: 6, 20). No significant between group differences were found for any of the other adverse event reported.
Second line therapy
One study (n=375) comparing latanoprost with brimonidine in patients with glaucoma or ocular hypertension inadequately controlled with monotherapy or dual therapy; 76% of those treated with latanoprost and 53% of those treated with brimonidine obtained a mean IOP reduction of at least 20 per cent from baseline to six months post-treatment. The mean IOP reduction was 1.9 mm Hg in favour of latanoprost (p<0.001).