{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:08:37Z","timestamp":1787616517114,"version":"build-2736575974"},"reference-count":45,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T00:00:00Z","timestamp":1728432000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Exper Ophthalmology"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>To evaluate and compare the long\u2010term efficacy of medical treatments for normal tension glaucoma (NTG) in controlling intraocular pressure (IOP), and establish a hierarchical ranking based on their effectiveness. \u2018Long\u2010term\u2019 is defined as a treatment duration of over 12\u2009weeks in randomised controlled trials (RCTs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This systematic review and model\u2010based network meta\u2010analysis (MBNMA) collected data of 795 patients with 997 eyes from RCTs. Patients with NTG were selected based on strict inclusion\/exclusion criteria, with randomsation procedures and masking as reported in the individual trials. Eight different medications were compared, including prostaglandin analogues, beta\u2010blockers, brimonidine, unoprostone isopropyl, brovincamine, and palmitoylethanolamide (PEA). Notably, PEA is an oral medication, while other drugs are topical agents.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Primary outcome is the long\u2010term efficacy of IOP control across medications with different follow\u2010up durations. Among the eight medications, PEA demonstrates the highest efficacy (Surface under the cumulative ranking, SUCRA\u2009=\u20097.46%), followed by two prostaglandin analogues: travoprost (SUCRA\u2009=\u20096.86%) and latanoprost (SUCRA\u2009=\u20096.76%), then two beta\u2010blockers: nipradilol (SUCRA\u2009=\u20094.90%) and timolol (SUCRA\u2009=\u20094.89%). Both brimonidine and unoprostone isopropyl have SUCRA scores below 4.0%, indicating modest but limited efficacy. Brovincamine has the lowest SUCRA score (1.32%), reflecting minimal effectiveness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study revealed PEA as a promising agent for long\u2010term IOP control in NTG patients, suggesting potential use as primary or adjunctive therapy. The outcomes call for PEA's consideration in clinical practice and highlight the need for further research into its long\u2010term efficacy and safety for NTG.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ceo.14447","type":"journal-article","created":{"date-parts":[[2024,10,10]],"date-time":"2024-10-10T12:44:29Z","timestamp":1728564269000},"page":"39-53","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Comparative analysis of medical treatments for long\u2010term control of normal tension glaucoma: A systematic review and model\u2010based network meta\u2010analysis"],"prefix":"10.1111","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0767-6058","authenticated-orcid":false,"given":"Ting\u2010Kai","family":"Yang","sequence":"first","affiliation":[{"name":"Department of General Medicine National Taiwan University Hospital  Taipei Taiwan"},{"name":"College of Medicine National Taiwan University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3210-201X","authenticated-orcid":false,"given":"Hou\u2010Ting","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of General Medicine China Medical University Hospital  Taichung Taiwan"},{"name":"School of Medicine, College of Medicine China Medical University  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7631-1096","authenticated-orcid":false,"given":"Yuh\u2010Jen","family":"Ju","sequence":"additional","affiliation":[{"name":"College of Medicine National Taiwan University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun\u2010Yi","family":"Chen","sequence":"additional","affiliation":[{"name":"College of Medicine National Taiwan University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen\u2010Hsien","family":"Chen","sequence":"additional","affiliation":[{"name":"College of Medicine National Taiwan University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert Y.","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Stanford University School of Medicine  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7880-9198","authenticated-orcid":false,"given":"Chun\u2010Ju","family":"Lin","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine China Medical University  Taichung Taiwan"},{"name":"Department of Optometry Asia University  Taichung Taiwan"},{"name":"Department of Ophthalmology China Medical University Hospital, China Medical University  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chien\u2010Chang","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine National Taiwan University Hospital  Taipei Taiwan"},{"name":"Center for Intelligent Healthcare National Taiwan University Hospital  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0884-0859","authenticated-orcid":false,"given":"Jennifer Hui\u2010Chun","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology China Medical University Hospital, China Medical University  Taichung Taiwan"},{"name":"Center for Translational Genomics &amp; 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