SYSTEMATIC REVIEW article
Front. Med.
Sec. Ophthalmology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1642986
Efficacy and Safety of Prostaglandin Drugs for Elevated Intraocular Pressure: A Bayesian Network Meta-Analysis
Provisionally accepted
- 1Chengdu University of Traditional Chinese Medicine, Chengdu, China
- 2Beijing Tongren Eye Center, Beijing, China
- 3Guangzhou University of Chinese Medicine, Guangzhou, China
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Objective To evaluate and compare the effectiveness and safety of latanoprost, bimatoprost, travoprost, and tafluprost in lowering intraocular pressure (IOP) in individuals with glaucoma or ocular hypertension. Methods We searched PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) published up to April 2025 comparing latanoprost, bimatoprost, travoprost, and tafluprost in adults with glaucoma or ocular hypertension. Primary outcomes were IOP reduction and conjunctival hyperemia. We assessed study quality using the Cochrane Risk of Bias 2.0 tool. Evidence certainty was evaluated with the CINeMA framework. A Bayesian network meta-analysis was conducted in RStudio. This review is registered with PROSPERO (CRD420251034803). Results 25 RCTs published between 2001 and 2024, involving 4,045 participants, were included. All studies compared monotherapy with latanoprost, bimatoprost, travoprost, or tafluprost. Among these, bimatoprost showed the most effective reduction in intraocular pressure compared to latanoprost (mean difference[MD]0.69;95%confidence interval[CI] 0.28-1.1;SUCRA 95.6%; moderate confidence). It also performed significantly better than travoprost (MD 0.64;0.14-1.09; 39.2%; low confidence). No other comparisons showed statistically significant differences. Overall, the quality of evidence for this outcome ranged from low to moderate. In terms of safety, 16 trials, including 3,119 participants, reported on conjunctival hyperemia. Both bimatoprost (odds ratio[OR] 3.3; 2.5-4.5; 18.4%, high confidence) and travoprost (0.46; 0.33-0.63; 55%, high confidence) were associated with a higher risk of hyperemia compared to latanoprost. Bimatoprost also posed a significantly greater risk than travoprost (1.51; 1.06-2.16, high confidence). Conclusion Bimatoprost provided the greatest IOP reduction but carried a higher risk of conjunctival hyperemia. Latanoprost and tafluprost offered balanced efficacy with better tolerability, making them suitable for patients with mild disease.
Keywords: Intraocular Pressure, Glaucoma, Prostaglandin analogs, Network meta-analysis, Bayesian
Received: 07 Jun 2025; Accepted: 28 Jul 2025.
Copyright: © 2025 Peng, Pang, Huang and Duan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Junguo Duan, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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