OBJECTIVES: This study assessed the comparative efficacy of latanoprostene bunod (LBN) and other topical treatments for open-angle glaucoma and ocular hypertension through a systematic literature review and a network meta-analysis(NMA), and especially compared LBN to other prostaglandin analogues (PGAs) in terms of intraocular pressure (IOP) reduction.

METHODS: The systematic literature review was performed as an update of the study by Li et al. (Ophthalmology, 2016). A search through Medline, EmBase and Pubmed to include studies published over 2014 until May 2018 was conducted.Studies were selected if they reported relative efficacy between at least two treatments (apraclonidine, brimonidine, betaxolol, carteolol, levobunolol, timolol, brinzolamide, dorzolamide, bimatoprost 0.01%, bimatroprost 0.03%, latanoprost, travoprost, tafluprost, unoprostone, latanoprostene bunod, or placebo), in IOP reduction after 3 months of usage. A Bayesian framework with random effect model was used to provide the relative effect in terms of mean difference (MD) of IOP reduction. The ranking probability of being more effective and the surface under cumulative ranking rate (SUCRA) was obtained. Sensitivity analyses excluding studies identified as causing heterogeneity and inconsistency were also conducted.

RESULTS: A total of 104 studies were retained for this NMA. LBN was shown to be significantly more effective in lowering IOP than apraclonidine (MD (95% IC) = -2.55 (-4.54; -0.51)), brimonidine (-1.81 (-3.09; -0.51)), betaxolol (-2.9 (-4.21; -1.6)), timolol (-1.69 (-2.81; -0.57)), brinzolamide (-2.9 (-4.32; -1.48)) and dorzolamide (-2.88 (-4.19; -1.55)). LBN was numerically more effective than all PGAs commercialized in Canada (except bimatoprost 0.03%), although results were not statistically significant. According to SUCRA ranking, bimatoprost 0.03% was first (94%), followed by LBN (88%) and bimatoprost 0.01% (83%). Sensitivity analyses provided similar conclusions.

CONCLUSIONS: LBN numerically outperformed the three most widely used PGAs, namely latanoprost, travoprost and bimatoprost 0.01% in IOP reduction.