Abstract：
Netarsudil is a Rho kinase inhibitor and the first new class of clinically useful ocular hypotensive agents. In this study, we conducted a systematic literature review and meta-analysis to summarize and synthesize the available evidence on the efficacy and safety of fixed-dose combination (FDC) therapy with netarsudil/latanoprost in patients with glaucoma.
We identified relevant studies in PubMed, Ovid Medline, Embase, and Cochrane Central until April 2021. The quality of the studies and the level of evidence were assessed using the Risk of Bias tool. Efficacy was measured as the mean difference in reducing intraocular pressure (IOP), and safety was assessed by the risk of conjunctival hyperemia (CH) due to FDC therapy, netarsudil monotherapy, or latanoprost monotherapy.
Four studies met the predefined eligibility criteria and were included in the meta-analysis. The mean difference in the reduction in IOP after 2 weeks and 4 to 6 weeks of drug administration was -2.41 mmHg (95% confidence interval [CI], -2.95 to -1.87) and -1.77 mmHg (95% CI, -2.31 to -1.87), respectively, in patients receiving FDC therapy versus those receiving latanoprost monotherapy. On the other hand, latanoprost monotherapy had a greater effect in reducing IOP than netarsudil monotherapy after 4 to 6 weeks of administration (mean difference, 0.95 mmHg; 95% CI, 0.43 to 1.47). The risk of CH was significantly higher with both FDC therapy and netarsudil monotherapy compared to latanoprost monotherapy in week 12, where the relative ratio was 3.01 (95% CI, 1.95 to 4.66) and 2.33 (95% CI, 1.54 to 3.54), each.
Netarsudil/latanoprost FDC therapy has a significantly greater effect on reducing IOP than latanoprost alone. The symptoms of CH were mostly mild, and only a few glaucoma patients discontinued the medication owing to CH in earlier clinical trials. Therefore, it would be beneficial to consider the administration of netarsudil/latanoprost FDC therapy in patients with glaucoma.
We identified relevant studies in PubMed, Ovid Medline, Embase, and Cochrane Central until April 2021. The quality of the studies and the level of evidence were assessed using the Risk of Bias tool. Efficacy was measured as the mean difference in reducing intraocular pressure (IOP), and safety was assessed by the risk of conjunctival hyperemia (CH) due to FDC therapy, netarsudil monotherapy, or latanoprost monotherapy.
Four studies met the predefined eligibility criteria and were included in the meta-analysis. The mean difference in the reduction in IOP after 2 weeks and 4 to 6 weeks of drug administration was -2.41 mmHg (95% confidence interval [CI], -2.95 to -1.87) and -1.77 mmHg (95% CI, -2.31 to -1.87), respectively, in patients receiving FDC therapy versus those receiving latanoprost monotherapy. On the other hand, latanoprost monotherapy had a greater effect in reducing IOP than netarsudil monotherapy after 4 to 6 weeks of administration (mean difference, 0.95 mmHg; 95% CI, 0.43 to 1.47). The risk of CH was significantly higher with both FDC therapy and netarsudil monotherapy compared to latanoprost monotherapy in week 12, where the relative ratio was 3.01 (95% CI, 1.95 to 4.66) and 2.33 (95% CI, 1.54 to 3.54), each.
Netarsudil/latanoprost FDC therapy has a significantly greater effect on reducing IOP than latanoprost alone. The symptoms of CH were mostly mild, and only a few glaucoma patients discontinued the medication owing to CH in earlier clinical trials. Therefore, it would be beneficial to consider the administration of netarsudil/latanoprost FDC therapy in patients with glaucoma.
摘要：
Netarsudil是一种Rho激酶抑制剂，是一类新的临床有用的降眼压药。在这项研究中,我们进行了系统的文献综述和荟萃分析,以总结和综合固定剂量联合(FDC)治疗青光眼患者的疗效和安全性的现有证据.
我们在PubMed中确定了相关研究，OvidMedline,Embase,和CochraneCentral，直到2021年4月。使用偏差风险工具评估研究质量和证据水平。疗效测量为降低眼内压（IOP）的平均差异，通过FDC治疗引起的结膜充血（CH）的风险来评估安全性，奈达舒地尔单药治疗,或拉坦前列素单一疗法。
四项研究符合预定的资格标准，并被纳入荟萃分析。给药2周和4-6周后眼压降低的平均差异为-2.41mmHg(95%置信区间[CI],-2.95至-1.87）和-1.77mmHg（95%CI，-2.31至-1.87），分别,在接受FDC治疗的患者与接受拉坦前列素单药治疗的患者中。另一方面,在给药4至6周后，拉坦前列素单药治疗在降低IOP方面的效果优于依塔舒地尔单药治疗（平均差异，0.95mmHg；95%CI，0.43至1.47）。在第12周，与拉坦前列素单药治疗相比，FDC治疗和依塔舒地尔单药治疗的CH风险明显更高，其相对比率分别为3.01（95％CI，1.95至4.66）和2.33（95％CI，1.54至3.54），each.
与单独使用拉坦前列素相比，伊塔苏地尔/拉坦前列素FDC治疗对降低IOP的作用明显更大。CH的症状大多轻微，在早期的临床试验中，只有少数青光眼患者因CH而停止了药物治疗。因此,考虑在青光眼患者中给予依塔舒地尔/拉坦前列素FDC治疗将是有益的.
我们在PubMed中确定了相关研究，OvidMedline,Embase,和CochraneCentral，直到2021年4月。使用偏差风险工具评估研究质量和证据水平。疗效测量为降低眼内压（IOP）的平均差异，通过FDC治疗引起的结膜充血（CH）的风险来评估安全性，奈达舒地尔单药治疗,或拉坦前列素单一疗法。
四项研究符合预定的资格标准，并被纳入荟萃分析。给药2周和4-6周后眼压降低的平均差异为-2.41mmHg(95%置信区间[CI],-2.95至-1.87）和-1.77mmHg（95%CI，-2.31至-1.87），分别,在接受FDC治疗的患者与接受拉坦前列素单药治疗的患者中。另一方面,在给药4至6周后，拉坦前列素单药治疗在降低IOP方面的效果优于依塔舒地尔单药治疗（平均差异，0.95mmHg；95%CI，0.43至1.47）。在第12周，与拉坦前列素单药治疗相比，FDC治疗和依塔舒地尔单药治疗的CH风险明显更高，其相对比率分别为3.01（95％CI，1.95至4.66）和2.33（95％CI，1.54至3.54），each.
与单独使用拉坦前列素相比，伊塔苏地尔/拉坦前列素FDC治疗对降低IOP的作用明显更大。CH的症状大多轻微，在早期的临床试验中，只有少数青光眼患者因CH而停止了药物治疗。因此,考虑在青光眼患者中给予依塔舒地尔/拉坦前列素FDC治疗将是有益的.
