Study Reaffirms Value of Prostaglandins in Glaucoma Therapy

Prostaglandin analogs were shown to be the most effective class of glaucoma medications, both as monotherapies and in combination therapies. Photo: James L. Fanelli, OD. Click image to enlarge. With a wide range of medications available today for glaucoma patients, knowing the efficacy among monotherapies and combination therapies is critical. Most practitioners initiate topical therapy with a prostaglandin analog (PGA) drug, an approach borne out by recent research in Journal of Glaucoma.A total of 166 randomized controlled trials with 36,494 participants comparing IOP-lowering effects of topical glaucoma monotherapies and combinations in patients with primary open angle glaucoma or ocular hypertension were included. The medications evaluated included prostaglandin analogs, E-prostanoid subtype 2 (EP2) receptor agonists, alpha adrenergic agonists, beta-blockers, carbonic anhydrase inhibitors (CAIs), ROCK inhibitors and their combinations. A network meta-analysis was performed to calculate the weighted mean difference in IOP reduction among treatments. Prostaglandin-based combinations emerged as the most effective options, demonstrating the greatest IOP reduction. Adding a CAI as second-line agent ranked highest, while adding a beta-blocker was the least effective.Among prostaglandin analogs, latanoprostene bunod was the most effective, owing to its addition of trabecular outflow improvement through the effect of nitric oxide, though the differences were not deemed statistically significant in this study. EP2 agonists may be less effective than other prostaglandin analogs, according to this study, but this class  demonstrated superior efficacy compared to most other agents evaluated. In addition, its combination with timolol demonstrated notable efficacy, surpassing prostaglandin/beta-blocker combo therapy, the authors added.ROCK inhibitor monotherapy achieved a slightly lower score compared to alpha agonists and beta-blockers, yet they were significantly more effective than CAI therapy. The netarsudil/latanoprost combination emerged as particularly effective, outperforming a widely used fixed combination of PGA/beta-blocker as well as non-PGA-based combination therapies.Click here for the journal source. Hsia Y, Wang C, Su C, et al. Efficacy and drug interactions of glaucoma medications: A systematic review and component network meta-analysis. Ophthalmology. July 21, 2025. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.