Meta-analysis of 13 randomized controlled trials comparing bimatoprost with latanoprost in patients with elevated intraocular pressure

Objective: This meta-analysis was performed to evaluate the efficacy and tolerability of bimatoprost compared with latanoprost in reducing intraocular pressure (IOP). Methods: Pertinent studies were identified through searches of PubMed, EMBASE, the Chinese Biomedicine Database, and the Cochrane Controlled Trials Register up to February 1, 2008, using the terms bimatoprost, Lumigan, latanoprost, and Xalatan. Searches of meeting abstracts and the manufacturers' databases were also performed. Randomized controlled trials comparing bimatoprost with latanoprost in patients with elevated IOP were selected. The main efficacy measures were the weighted mean difference (WMD) in the percentage of IOP reduction (IOPR%) and the rate difference (RD) in the percentage of patients with a target IOP of <= 17 mm Hg. The main tolerability measure was the RD for adverse events. Results: Thirteen studies enrolling a total of 1302 patients were included in the meta-analysis. Mean age ranged from 52 to 71 years. The majority of patients for whom these data were available were women (647/1133 [57.1%]) and white (709/1019 [69.6%]). Bimatoprost was associated with greater reductions from baseline in morning IOP compared with latanoprost, with a WMD for the IOPR% of 2.59% (95% CI, 0.81 to 4.37) at 1 month (P = 0.004, test for overall effect), 2.41% (95% CI, 0.58 to 4.25) at 3 months (P = 0.01, test for overall effect), and 5.60% (95% Cl, 2.95 to 8.26) at 6 months (P < 0.001, test for overall effect). There was a numerically greater but nonsignificant percentage reduction in diurnal IOP with bimatoprost at 3 months compared with latanoprost, with a WMD for the IOPR% of 2.10% (95% CI, -0.46 to 4.65). Numerically greater proportions of bimatoprost patients than latanoprost patients achieved the target IOP at all time points, with a pooled RD of 5% (95% CI, -9 to 18) at 1 month, 12% (95% CI, 4 to 21) at 3 months (P = 0.004, test for overall effect), and 11% (95% CI, 0 to 23) at 6 months. Bimatoprost was associated with a significantly greater frequency of hyperemia than latanoprost, with an RD of 20% (95% CI, 15 to 24). Rates of serious ocular adverse events did not differ significantly between bimatoprost and latanoprost, with an RD of -1% (95% CI, -2 to 1) for ocular inflammation and 0% (95% CI, -2 to 2) for cystold macular edema. Conclusions: Bimatoprost was associated with significantly greater efficacy in lowering morning IOP than latanoprost at all time points. Comparable proportions of patients reached the IOP target with bimatoprost and latanoprost. Both agents were well tolerated, although bimatoprost was associated with a significantly greater frequency of conjunctival hyperemia than latanoprost.