Preservative-free 0.01% bimatoprost versus other formulations for glaucoma and OHT: Systematic review and meta-analysis of efficacy and safety.
Alina Popa Cherecheanu, Ronald Marinus Petrus Cornelis de Crom, Louise Baschet et al.
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In 30 seconds
This systematic review and Bayesian network meta-analysis assessed efficacy and safety of preservative-free bimatoprost 0.01% versus preserved or higher-concentration bimatoprost in adults with glaucoma or ocular hypertension. Four randomised controlled trials were included, with mean intraocular pressure at Week 12 as the primary endpoint. Preservative-free 0.01% was non-inferior to all other formulations for IOP lowering, with every 95% credible interval within the 1.5 mmHg non-inferiority margin. Hyperaemia outcomes generally favoured preservative-free formulations, although the authors note that longer-term studies are needed.
Key findings
- Across four included trials, preservative-free bimatoprost 0.01% was non-inferior to other formulations for IOP lowering; all 95% credible intervals were within the 1.5 mmHg margin.
- At Week 12, no hyperaemia was reported in 57.3% with preservative-free 0.01% versus 43.6% with preserved formulations.
- Worsening hyperaemia scores occurred in 18.3% versus 30.4%, respectively.
- Hyperaemia as an adverse event was less frequent with bimatoprost 0.01% than 0.03% (28.6% vs. 37.4%).
Why it matters
The analysis suggests that removing the preservative from bimatoprost 0.01% can retain short-term IOP-lowering efficacy while reducing conjunctival hyperaemia compared with preserved or higher-concentration formulations. These comparative findings may help inform consideration of formulation-related tolerability, but the evidence is based on a small set of trials and does not establish long-term benefits.
What to keep in mind
Only four studies were included, and the primary efficacy endpoint was at Week 12. The authors state that further long-term studies are needed.