Original article
Current Status of Prostaglandin Therapy: Latanoprost and Unoprostone☆

https://doi.org/10.1016/S0039-6257(02)00308-9Get rights and content

Abstract

Latanoprost, a prostaglandin F2α analog prodrug, and unoprostone, an analog of a prostaglandin metabolite, have been shown to be effective in decreasing intraocular pressure when used alone or in combination with other ocular hypotensive agents. The increase in the uveoscleral outflow and some of the side effects are probably FP-receptor mediated, which may account for some differences between the cited drugs. This article reviews the recent literature available on the clinical efficacy of these prostanoids, as well as the studies directly comparing these drugs.

Section snippets

Efficacy of Latanoprost

The clinical efficacy of latanoprost used as a monotherapy has been well established by several studies. In multicenter, randomized, double-masked trials carried out for 3 to 6 months involving over 1,000 patients with ocular hypertension or glaucoma, 0.005% latanoprost once daily was found to be more effective than, or at least as effective as, 0.5% timolol applied twice daily.1, 16, 52, 93 A pooled data analysis of three of these randomized studies has recently been performed.31 A group of

Efficacy of Unoprostone

Previous studies in Japan of administration of unoprostone twice daily as monotherapy in ocular hypertension or primary open-angle glaucoma have shown IOP reductions between 11% and 23%.9, 10, 84 Unoprostone has also been compared directly to timolol in a short-term, randomized study.79 The IOP was reduced from baseline by 4.1 ± 4.1 mm Hg for unoprostone twice daily and by 6.3 ± 2.4 mm Hg for timolol. This difference was not statistically significant. However, the study had only a 40% power to

Comparison of Latanoprost and Unoprostone as Monotherapy

Susanna et al81 compared the IOP-reducing effects of latanoprost and unoprostone in patients with primary open-angle glaucoma and ocular hypertension. A total of 108 patients were randomized to receive latanoprost or unoprostone after wash-out of previous ocular hypotensive medication. After 8 weeks of treatment, latanoprost reduced the mean IOP of 6.7 mm Hg (28%) and unoprostone by 3.3 mm Hg (14%). The difference of 3.4 mm Hg was significant (p < 0.001) in favor of latanoprost. A mean IOP of

Comparison of Latanoprost and Unoprostone as Additive Therapy

Latanoprost monotherapy seems to be as good as some forms of combined therapy. Switching to latanoprost monotherapy in patients not adequately controlled by timolol alone is at least as effective in reducing the mean diurnal IOP as substituting a fixed timolol-pilocarpine combination for timolol.12, 57 Also, latanoprost monotherapy was at least as effective as the addition of dorzolamide in glaucoma patients whose pressures were not adequately controlled with timolol.22, 46

Several studies have

Efficacy of Latanoprost and Unoprostone in Treating Different Types of Glaucoma

Several studies have evaluated the effects of topical prostaglandins in the treatment of other types of glaucomas. Aung et al6 compared the IOP-reducing effect of latanoprost to that of timolol in patients with chronic primary angle-closure glaucoma. In this preliminary study, 32 Asian patients were randomized to a 2-week treatment with latanoprost or timolol. In the latanoprost group the mean IOP reduction was 34% (8.8 mm Hg), whereas it was 23% (5.7 mm Hg) in the timolol group. In another

Side Effects

Several ocular side effects have been reported with prostaglandin analogs used in the treatment of glaucoma. It has been reported to increase length, number, colorization, and thickness of eyelashes, and hypertrichosis.37, 47, 73 It appears that unoprostone has a similar effect to that of latanoprost with regard to lashes.

It is possible that latanoprost aggravates epithelial herpes and increases the risk of recurrences of herpetic keratitis.39, 90 In rabbits, unoprostone does not cause the HSV

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