The efficacy and safety of Timolol-Brimonidine fixed combination therapy in Glaucoma treatment compared to Timolol and Brimonidine monotherapy

Abstract

Efficacy and safety of Timolol-Brimonidine combination therapy are studied in some articles and literatures, but there is no consensus among researchers about adverse effects of these medication. Hence, in order to reach comprehensive attitude in this issue, this study was conducted. Methods: PubMed, Scopus, ProQuest, Cochrane, Web of Science, OVID databases as well as Iranian databases were used to retrieve English articles published between January 1980 and August 2020. Then, after removing duplications, all articles were screened in three stages by two experts. In the next step, two evaluators evaluated the selected studies in terms of bias risk using standardized critical appraisal instruments. Finally, the results of eligible studies by meta-analysis or descriptive were reported. The meta-analysis was done using the software CMA v2.0. Results: the results of six out of 1932 retrieved studies show the superiority of Timolol-Brimonidine in comparison to Timolol in reducing intraocular pressure (IOP). Also, in order to evaluate efficacy of these medications, three studies were included in the meta-analysis which results significantly indicate the superiority of the Timolol-Brimonidine combination over Timolol in reducing IOP. Two studies comparing Timolol-Brimonidine combination with Brimonidine in reducing IOP, indicated the superiority of combination therapy. In order to compare the safety of Timolol-Brimonidine combination with Timolol, three studies were reviewed which in 2 studies, more adverse effects were reported in the combination group. Also, in three studies reporting the safety of Timolol-Brimonidine with Brimonidine, the frequency of adverse effects were less in the Timolol-Brimonidine combination group.