Efficacy of Topical Timolol in Chronic Unhealed Ulcers: A Systematic Review and Meta-Analysis.
Muhammad M Elsharkawy, Eslam Mohammed Rabea, Anas Ashraf Elassal et al.
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In 30 seconds
This systematic review and meta-analysis assessed topical timolol for chronic unhealed ulcers. Six studies were included: two single-arm studies and four comparative studies (three randomised trials and one cohort study). Meta-analysis pooled the four comparative studies of venous ulcers. Compared with control, timolol was associated with greater ulcer-area reduction at 2 weeks (-23.63%; 95% CI: -29.26 to -18.00), 4 weeks (-41.40%; 95% CI: -49.57 to -33.23), and 12 weeks (-23.38%; 95% CI: -39.43 to -7.33). Complete healing was significantly more frequent at 4 weeks, but not at 12 weeks.
Key findings
- In pooled venous-ulcer studies, ulcer area was reduced more with timolol than control at 2 weeks (-23.63%; 95% CI: -29.26 to -18.00).
- Greater ulcer-area reduction with timolol was also reported at 4 weeks (-41.40%; 95% CI: -49.57 to -33.23) and 12 weeks (-23.38%; 95% CI: -39.43 to -7.33).
- Complete healing favored timolol at 4 weeks (RR: 12.00; 95% CI: 1.68 to 85.84; p = 0.01), but the 12-week result was not significant (RR: 3.79; 95% CI: 0.44 to 32.54; p = 0.22).
Why it matters
Chronic venous ulcers can be difficult to heal, and these pooled findings suggest topical timolol may reduce ulcer area over several measured time points. The distinction between area reduction and complete healing is important: evidence for complete healing was statistically significant only at 4 weeks, while the 12-week estimate was imprecise and not significant.
What to keep in mind
The authors note small sample sizes, lack of blinding, and inclusion of only four studies in the meta-analysis, limiting generalizability.