拉坦前列素-噻吗心安联合用药与单用拉坦前列素24h眼压控制效果比较

Objective: To evaluate the 24- hour efficacy and safety of the latanoprost-timolol maleate-fixed combination vs latanoprost therapy in patients with primary open-angle glaucoma. Methods: A prospective, observer-masked, crossover, activecontrolled, randomized comparison in which after a 6- week medicine-free period, patients were randomized to either latanoprost-timolol-fixed combination therapy or latanoprost therapy, both dosed once each evening, alone for 8 weeks. Patients were then switched to the opposite treatment for 8 weeks. At the end of the washout and treatment periods, a 24- hour diurnal curve was performed. Results: The baseline untreated mean± SD diurnal curve in 37 patients who completed the study was 24.2± 2.0 mm Hg. The mean diurnal curve was 19.2± 2.6 mm Hg for those who received latanoprost therapy alone and 16.7 ± 2.1 mm Hg for those who received the fixed combination therapy (P<.001). The fixed combination therapy also provided a lower absolute intraocular pressure level (1.5- 2.9 mm Hg, P<.001) and a greater intraocular pressure reduction from the untreated baseline (P<.001). Stinging was statistically lower with latanoprost therapy alone (P=.04), but itching was statistically increased compared with the fixed combination therapy (P=.04). Conclusion: The result of this study suggests that the latanoprost-timolol-fixed combination compared with latanoprost therapy alone provides improved intraocular pressure reduction over the 24- hour diurnal curve and for each individual time point in patients with primary open-angle glaucoma.

溴莫尼定或多佐胺加入拉坦前列素对原发性开角型青光眼患者24h眼压的影响

Objective: To evaluate the 24-hour efficacy of brimonidine purite versus dorz olamide, each added to latanoprost. Design: Double-masked, 2-center, prospecti ve, crossover comparison. Participants: Primary open-angle glaucoma (POAG) subj ects. Methods: Subjects were randomized to brimonidine purite or dorzolamide, ea ch given twice daily, for the first 6-week treatment period after a 6-week lat anoprost run-in. Subjects began the opposite treatment for the second 6-week p eriod after a 6-week latanoprost-only treatment between periods. Intraocular p ressure (IOP) was measured at 8 am, 12 pm, 4 pm, 8 pm, 12 am, 4 am, and 8 am at each baseline and at the end of each treatment period. This study provided an 80 %power that a 1.5-mmHg difference could be excluded between groups if 27 subje cts completed the study. A standard deviation (SD) of 2.8 mmHg was assumed. Main Outcome Measures: Twentyfour-hour efficacy of intraocular pressures of brimoni dine purite versus dorzolamide, each added to latanoprost. Results: In 31 comple ted subjects, the baseline mean diurnal 24-hour IOP (±SD) was 19.0±1.7 mmHg f or brimonidine purite and 19.0±1.6 mmHg for dorzolamide (P=0.52). The 8 am IOP after 6 weeks of therapy was 18.4±2.1 mmHg for brimonidine purite and 18.9±1.9 mmHg for dorzolamide (P=0.40). The mean diurnal IOP was 16.9±1.5 mmHg for brim onidine purite and 16.8±1.5 mmHg for dorzolamide (P=0.66). Dorzolamide caused a more bitter taste (P=0.01) than brimonidine purite. Conclusions: This study sug gests that brimonidine purite and dorzolamide, added to latanoprost, have simila r efficacy and safety in POAG or ocular hypertensive subjects.

0.2%溴莫尼定、0.15%乌诺前列酮分别加入0.5%马来酸噻吗洛尔眼液2次/d治疗原发性开角型青光眼或高眼压症

Purpose. To compare the efficacy and safety of brimonidine 0.2% vs unoprostone 0.15% , both added to timolol maleate 0.5% each given twice daily. Methods. In this prospective, multi-centred, double-masked, crossover comparison, patients were randomized to one treatment group for a 6- week treatment period, and then crossed over to the opposite treatment. Measurements were performed at 0800, 1000, 1600, 1800, and 2000 h at baseline and at the end of each treatment period. Results. In all,33 patients entered this trial and 29 completed. The baseline trough intraocular pressure (IOP) was 23.3± 2.4 and the diurnal curve IOP was 22.0± 1.3mmHg. For the brimonidine and timolol maleate treatment group, the trough IOP was 21.6± 3.3 and the diurnal curve IOPwas 19.8± 2.1mmHg,while the timolol and unoprostone treatment showed a trough IOP of 20.9± 3.8 and a diurnal curve IOP of 19.3± 2.4 mmHg. There was no significant difference between treatment groups at any time point for the diurnal curve,or in the reduction from baseline (P >0.05). Both treatments failed to statistically reduce the IOP from baseline at 1800h. There was no difference between treatment groups regarding ocular and systemic unsolicited adverse events, but patients admitted to more dryness (P=0.02) and burning upon instillation (P< 0.0001) with unoprostone by survey. Conclusion. Brimonidine 0.2% or unoprostone 0.15% added to timolol maleate 0.5% provide similar efficacy and safety throughout the daytime diurnal curve.

0.005%拉坦前列素与0.03%比马前列素治疗原发性开角型青光眼的疗效评比

Objective: To evaluate latanoprost versus bimatoprost given each evening over the 24- hour diurnal curve. Design: Double- masked, 2- center, crossover comparison. Participants: Forty- two of 44 patients with primary open- angle glaucoma (POAG) completed the study. Methods: Consecutive patients were not treated during a baseline 24- hour curve after a glaucoma medicine- free period. They then were randomized to either latanoprost or bimatoprost for a 7- week treatment period. Diurnal curve intraocular pressures (IOPs) were measured at treatment period end at 2 AM, 6 AM, 10 AM, 2 PM, 6 PM, and 10 PM. After the first treatment period, patients were changed to the opposite medicine without a medicine- free period. Diurnal curve measurements were performed again at the end of the second 7- week treatment period. Main Outcome Measure: The 24- hour diurnal IOP. Results: On the last day of treatment, mean 24- hour IOPs were 17.3± 2.8 mmHg for latanoprost and 16.7± 2.4 mmHg for bimatoprost (P=0.01). The 6 PM individual time point for IOP was statistically lower for bimatoprost after a Bonferroni correction (P=0.008). The largest IOP difference at any time point was 0.9 mmHg at 6 PM. The most common side effect was conjunctival hyperemia, which occurred less with latanoprost (n=6) than with bimatoprost (n= 15) (P=0.004). Two patients had their treatments discontinued while on bimatoprost, one due to conjunctival hyperemia and the other due to ocular intolerance. Conclusion: This study indicates that the 24- hour diurnal IOP is statistically lower in POAG with bimatoprost, compared with latanoprost, among patients who tolerated bimatoprost. However, the IOP difference between groups was small and may not be clinically meaningful. In contrast, conjunctival hyperemia seems statistically greater with bimatoprost. The exact clinical importance of conjunctival hyperemia, if any, needs to be clarified further.