A comparative study on safety and efficacy of travoprost and brimonidine/timolol fixed combination in patients of primary open angle glaucoma

Rekha Mehani, Saroj Gupta, Major V. K. Yadav, S. D. Shukla


Background: The purpose of this study was to compare and evaluate the clinical efficacy of topically applied travoprost 0.004% eye drops versus brimonidine/timolol fixed combination eye drops in the management of primary open-angle glaucoma.

Methods: In this prospective, randomized study, 65 patients received either travoprost eye drops once daily in the morning (n=33) or brimonidine/timolol fixed combination eye drops twice daily (n=32). Intra ocular pressure (IOP) was assessed at 2, 4, 8, and 12 weeks. The primary outcome measure was mean reduction in IOP.

Results: Thebaseline mean IOP values were similar between two groups. Mean reduction of IOP in the right eye for brimonidine/timolol fixed combination group was 9±2.9 mmHg, whereas in the left eye it was 10.9±2.8 mmHg. In the travoprost group, the reduction in IOP of the right eye was 7.8±2.9 mmHg (p=0.0002) and 7.5±3.4 mmHg (p=0.0001) in the left eye. The mean reduction of IOP for the brimonidine/timolol group was 9.95 mmHg and for the travoprost group it was 7.6 mmHg (p<0.0001) in both the eyes.

Conclusions: The fixed combination brimonidine/timolol twice daily demonstrated superior mean IOP lowering efficacy compared to travoprost 0.004% in patients with open-angle glaucoma.


Open-angle glaucoma, Intra ocular pressure, Timolol, Travoprost, Brimonidine

Full Text:



Quigley HA. Number of people with glaucoma worldwide. Br J Ophthalmol. 1996;80(5):389-93.

Congdon N, O’Colmain B, Klaver CC, Klein R, Muñoz B, Friedman DS, et al. Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol. 2004;122(4):477-85.

Thylefors B, Négrel AD. The global impact of glaucoma. Bull World Health Organ. 1994;72(3):323-6.

Five-year follow-up of the fluorouracil filtering surgery study. The Fluorouracil Filtering Surgery Study Group. Am J Ophthalmol. 1996;121(4):349-66.

The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration. The AGIS investigators. Am J Ophthalmol. 2000;130(4):429-40.

Heijl A, Leske MC, Bengtsson B, Hyman L, Bengtsson B, Hussein M; Early Manifest Glaucoma Trial Group. Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Arch Ophthalmol. 2002;120(10):1268-79.

Alward WC. Medical management of glaucoma. N Engl J Med. 1998;339:1298-307.

Kass MA, Heuer DK, Higginbotham EJ, Johnson CA, Keltner JL, Miller JP, et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol. 2002;120(6):701-13.

van der Valk R, Webers CA, Schouten JS, Zeegers MP, Hendrikse F, Prins MH. Intraocular pressure-lowering effects of all commonly used glaucoma drugs: a meta-analysis of randomized clinical trials. Ophthalmology. 2005;112(7):1177-85.

Schwartz K, Budenz D. Current management of glaucoma. Curr Opin Ophthalmol. 2004;15(2):119-26.

Netland PA, Landry T, Sullivan EK, Andrew R, Silver L, Weiner A, et al. Travoprost compared with latanoprost and timolol in patients with open-angle glaucoma or ocular hypertension. Am J Ophthalmol. 2001;132(4):472-84.

Dubiner HB, Sircy MD, Landry T, Bergamini MV, Silver LH, Darell Turner F, et al. Comparison of the diurnal ocular hypotensive efficacy of travoprost and latanoprost over a 44-hour period in patients with elevated intraocular pressure. Clin Ther. 2004;26(1):84-91.

Kiland JA, Gabelt BT, Kaufman PL. Studies on the mechanism of action and on the effects of ecothiophate on aqueous formation and outflow. Exp Eye Res. 2004;78:639 57.

Tripathi KD, editor. Essentials of Medical Pharmacology. 7th Edition. New Delhi: Jaypee Brother Medical Publication; 2013.

Harvey RB. Practical Ophthalmology - CD ROM. Birmingham: Palmtrees Publishing; 1998.

Ekström C. Risk factors for incident open-angle glaucoma: a population-based 20 - year follow-up study. Acta Ophthalmol. 2010;65:1971.

Heijl A, Leske MC, Bengtsson B, Hyman L, Bengtsson B, Hussein M, et al. Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Arch Ophthalmol. 2002;120(10):1268-79.

Nemesure B, Honkanen R, Hennis A, Wu SY, Leske MC; Barbados Eye Studies Group. Incident open-angle glaucoma and intraocular pressure. Ophthalmology. 2007;114(10):1810-5.

Miglior S, Zeyen T, Pfeiffer N, Cunha-Vaz J, Torri V, Adamsons I; European Glaucoma Prevention Study (EGPS) Group. Results of the European glaucoma prevention study. Ophthalmology. 2005;112(3):366-75.

Orme M, Collins S, Dakin H, Kelly S, Loftus J. Mixed treatment comparison and meta-regression of the efficacy and safety of prostaglandin analogues and comparators for primary open-angle glaucoma and ocular hypertension. Curr Med Res Opin. 2010;26(3):511-28.

Fung AT, Reid SE, Jones MP, Healey PR, McCluskey PJ, Craig JC. Meta-analysis of randomised controlled trials comparing latanoprost with brimonidine in the treatment of open-angle glaucoma, ocular hypertension or normal-tension glaucoma. Br J Ophthalmol. 2007;91(1):62-8.

Parrish RK, Palmberg P, Sheu WP; XLT Study Group. A comparison of latanoprost, bimatoprost, and travoprost in patients with elevated intraocular pressure: a 12-week, randomized, masked-evaluator multicenter study. Am J Ophthalmol. 2003;135(5):688-703.

Fechtner RD, Harasymowycz P, Nixon DR, Vold SD, Zaman F, Williams JM, et al. Twelve-week, randomized, multicenter study comparing a fixed combination of brimonidine-timolol with timolol as therapy adjunctive to latanoprost. Clin Ophthalmol. 2011;5:945-53