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Comparative Effectiveness of Timolol-Based Fixed-Combination Regimens for Glaucoma: a Retrospective Cohort Study
Chin Lai1, Avery Shuei-He Yang2,3, Shih-Chieh Shao3,4
1Department of Education, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.
Ophthalmology and Therapy
|March 17, 2026
Summary
Prostaglandin analog/timolol fixed combinations show better long-term effectiveness for glaucoma than carbonic anhydrase inhibitor/timolol or alpha-agonist/timolol. This reduces treatment failure and the need for further interventions.
Area of Science:
- Ophthalmology
- Pharmacology
- Public Health
Background:
- Glaucoma is a leading cause of irreversible blindness, often requiring combination therapy for intraocular pressure control.
- Limited real-world data exists comparing long-term effectiveness of different fixed-combination therapies involving timolol.
Purpose of the Study:
- To compare the long-term effectiveness of prostaglandin analog (PGA)/timolol, carbonic anhydrase inhibitor (CAI)/timolol, and alpha-agonist (AA)/timolol fixed-combination regimens in glaucoma patients.
Main Methods:
- A retrospective cohort study emulating a pragmatic trial using Taiwan's National Health Insurance Research Database (2011-2021).
- Propensity score overlap weighting and Cox proportional hazards models were used to compare treatment failure rates.
- Treatment failure was defined as initiating additional medications, surgery, laser treatment, or blindness.
Main Results:
- Prostaglandin analog (PGA)/timolol was associated with significantly lower treatment failure rates compared to CAI/timolol (HR: 0.85) and AA/timolol (HR: 0.87).
- PGA/timolol also reduced the need for additional medications and intraocular pressure-lowering procedures.
- No significant difference in treatment failure was observed between CAI/timolol and AA/timolol (HR: 0.97).
Conclusions:
- PGA/timolol fixed combinations demonstrate superior long-term effectiveness in a real-world setting compared to CAI/timolol and AA/timolol.
- These findings suggest PGA/timolol offers the most favorable outcomes among timolol-based fixed combinations for glaucoma management.
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