Prostaglandin Analogues for Ophthalmic Use: A Review of Comparative Clinical Effectiveness, Cost-Effectiveness, and Guidelines

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Project Status:
Completed
Project Line:
Health Technology Review
Project Sub Line:
Summary with Critical Appraisal
Project Number:
RC1248-000

Question

  1. What is the comparative clinical effectiveness of bimatoprost versus other prostaglandin analogues for ophthalmic use?
  2. What is the cost-effectiveness of bimatoprost versus other prostaglandin analogues for ophthalmic use?
  3. What are the evidence-based guidelines for the use of bimatoprost for elevated intraocular pressure?

Key Message

A total of 13 relevant publications were included in this report: five systematic reviews (including four meta-analysis and one network meta-analysis), seven randomized controlled trials, and one cost-effectiveness study. No evidence-based guidelines were identified from the literature within the last five years regarding the use of bimatoprost in lowering intraocular pressure.

The overall findings from the systematic reviews and clinical trials are seemingly contradictory. Results from the systematic reviews showed bimatoprost be clinically superior over other prostaglandin analogues (including latanoprost, travoprost, and tafluprost) with respect to intraocular pressure; whereas with the exception of a crossover trial, none of the randomized trials with a parallel group design demonstrated the clinical superiority of bimatoprost. Most studies concluded that the clinical profile of the four prostaglandin analogues is similar; with all four prostamides effective in reducing intraocular pressure in patients with open angle glaucoma or ocular hypertension, irrespective of prior treatment status or other risk factors. In terms of adverse events, bimatoprost was found to be relatively less tolerated compared to the others and may result in hyperemia and growth of eyelashes. However, these findings are not consistently reported in all trials, and the safety profile of the four prostamides may be similar. A single cost-effectiveness study from the United States showed bimatoprost to be the most cost-effective prostamide, using robust methodology and different perspectives (societal, third party insurance, and ophthalmic), although its applicability is debatable in the Canadian health care context.

The mixed and inconclusive findings across the studies may be a result of a number of factors: inclusion of studies that are heterogeneous in nature with respect to patient population, intervention (including dosage), assessment of study outcomes, and overall study design; as well as methodological limitations arising from small sample size, and inadequate reporting of data. Overall, bimatoprost appears to be at least as effective as latanoprost, travoprost, and tafluprost, either as monotherapy, or in combination with timolol. However, bimatoprost showed to be the most cost-effective prostamide, which may support its use over other alternatives.