請用此 Handle URI 來引用此文件：
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/95009完整後設資料紀錄
| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 杜裕康 | zh_TW |
| dc.contributor.advisor | Yu-Kang Tu | en |
| dc.contributor.author | 夏昀 | zh_TW |
| dc.contributor.author | Yun Hsia | en |
| dc.date.accessioned | 2024-08-26T16:13:52Z | - |
| dc.date.available | 2024-08-27 | - |
| dc.date.copyright | 2024-08-26 | - |
| dc.date.issued | 2024 | - |
| dc.date.submitted | 2024-08-06 | - |
| dc.identifier.citation | Reference
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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/95009 | - |
| dc.description.abstract | 本篇系統性回顧與網絡統合分析旨在評估青光眼藥物之降眼壓效果，比較單方和複方藥物在原發性隅角開放型青光眼或高眼壓症之病患的療效。共納入224項研究，42,260名參與者，比較36種和17類青光眼藥物的治療效果。在所有納入之藥物中，前三名有效皆為複方藥，分別為travoprost/ brinzolamide, latanoprost/brimonidine, brimonidine/ timolol/ dorzolamide。而前三名有效的單方藥為bimatoprost, latanoprostene bunod, latanoprost。此外本研究欲探討新型藥物相較於原有藥物的療效，發現新型的前列腺素omidenepag isopropyl (OMDI) 效果不如已有的前列腺素衍生物(PG)，降低眼壓效果排在bimatoprost, latanoprostene bunod, latanoprost, travoprost, tafluprost之後。然而，OMDI/timolol的組合療效較好，僅略低於bimatoprost/timolol，優於latanoprost, travoprost, tafluprost和timolol的組合。在ROCK激脢抑制劑(ROCKI)中netarsudil優於ripasudil和carbonic anhydrase inhibitors（C），而和β-阻滯劑（B）和α-2腎上腺素能促進劑（A）差不多，但效果不如前列腺素衍生物。而latanoprostene bunod作為一種效果優良的單一療法，效果僅次於bimatoprost。在複方藥物療效的部分，前列腺素衍生物之複方藥物優於非前列腺素衍生物之複方藥。而非前列腺素衍生物之複方藥物與效果較優良之前列腺素衍生物單方藥差不多，例如bimatoprost、latanoprostene bunod，較排名在後之前列腺素衍生物單方藥效果好，例如tafluprost、OMDI。在所有前列腺素衍生物之複方藥中，效果排名依次為PG+C、PG+A、PG+B+A、PG+ROCKI和PG+B。PG+B+A效果反而比PG+A來得弱，以及C作為降壓效果最弱的單方藥，其和PG之結合反而是效果最強的複方藥，這些與元件網絡統合分析的互動模式發現PG和C有加乘效應，而PG和B有拮抗效應互相應證。本研究提供了現有青光眼藥物的降低眼壓效果排名，為青光眼臨床治療選用藥物提供參考，並指出藥物間可能的交互作用，為開發新的複方療法提供基礎。 | zh_TW |
| dc.description.abstract | This systematic review and network meta-analysis (NMA) assessed the efficacy of monotherapy versus combination therapy in treating primary open angle glaucoma or ocular hypertension. We included 224 studies involving 42,260 participants to compare the treatment efficacy of 36 kinds and 17 categories of glaucoma medications. The top combination therapies, based on P-score, were travoprost/ brinzolamide, latanoprost/brimonidine, and brimonidine/ timolol/ dorzolamide, while the leading monotherapies included bimatoprost, latanoprostene bunod, and latanoprost. The effectiveness of newer glaucoma medications was also explored. Omidenepag isopropyl (OMDI) was less effective than established prostaglandin analog (PG), placing it after bimatoprost, latanoprostene bunod, latanoprost, travoprost, and tafluprost. However, its combination with timolol showed improved efficacy and was only inferior to bimatoprost/timolol. Netarsudil outperformed ripasudil (ROCKI) and carbonic anhydrase inhibitors (C) and matched β-blockers (B) and α-2 adrenergic agonists (A), though it was less effective than prostaglandin analogs. Latanoprostene bunod, positioned as a superior monotherapy ranking just below bimatoprost. Prostaglandin combinations generally surpassed non-prostaglandin combinations. Non-prostaglandin combinations demonstrated similar efficacy to high-ranking prostaglandin monotherapies, such as bimatoprost and latanoprostene bunod, and outperformed lower-ranking prostaglandin monotherapies like tafluprost and OMDI. The hierarchy of prostaglandin-based combination therapies—categorized as PG+C, PG+A, PG+B+A, PG+ROCKI, and PG+B—mirrored the interactive component NMA model findings of a synergistic effect between PG and C, contrasted with an antagonistic effect between PG and B. This research offers a detailed efficacy ranking of the extant glaucoma medications, providing a strategic guide for clinical practice and a foundation for developing novel combination therapies. | en |
| dc.description.provenance | Submitted by admin ntu (admin@lib.ntu.edu.tw) on 2024-08-26T16:13:52Z No. of bitstreams: 0 | en |
| dc.description.provenance | Made available in DSpace on 2024-08-26T16:13:52Z (GMT). No. of bitstreams: 0 | en |
| dc.description.tableofcontents | 口試委員會審定書 i
誌謝 ii 中文摘要 iii 英文摘要 iv Chapter1Introduction 1 1.1 Overview of glaucoma 1 1.2 Medical treatment of glaucoma 4 Chapter 2 Literature review 6 2.1 Efficacy of glaucoma medications 6 2.2 Limitations and gaps in the present literature 9 2.3 The interaction between different categories of medications 12 2.4 Heterogeneity of the treatment response of different medications 13 Chapter 3 Materials and Methods 14 3.1 Systemic review 14 3.1.1 Eligibility criteria 14 3.1.2 Search methods 17 3.1.3 Study selection and data extraction 17 3.1.4 Quality assessment 18 3.1.5 Certainty of Evidence in Network Estimates 18 3.2 Pairwise meta-analysis 19 3.3 Network meta-analysis 21 3.3.1 Contrast-based random-effect model 21 3.3.2 Reporting the outcomes 22 3.3.3 Assessment of transitivity 24 3.3.4 Assessment of network heterogeneity and consistency 24 3.4 Component network meta-analysis 27 3.5 Detecting the heterogeneity of treatment effects 28 3.6 Statistical significance 29 Chapter 4 Results 30 4.1 Systemic review 30 4.2 The assessment of transitivity and risk of bias 31 4.3 The results of NMA for the treatment efficacy of glaucoma medications 36 4.3.1 Treatment efficacy of different kinds of glaucoma medications 36 4.3.1.1 The results of pairwise comparisons 36 4.3.1.2 The results of network meta-analysis 41 4.3.1.3 The treatment efficacy of ROCKI 44 4.3.1.4 The treatment efficacy of EP2 receptor agonist 45 4.3.1.5 The treatment efficacy of latanoprostene bunod 46 4.3.1.6 The comparison of treatment efficacy between different combination therapies 48 4.3.2 Treatment efficacy of different categories of glaucoma medications 50 4.3.2.1 The results of pairwise comparison 50 4.3.2.2 The results of network meta-analysis 53 4.3.2.3 The comparison of monotherapies 57 4.3.2.4 The treatment efficacy of ROCKI 57 4.3.2.5 The treatment efficacy of EP2 receptor agonists 58 4.3.2.6 The treatment efficacy of latanoprostene bunod 59 4.3.2.7 The comparison of combination therapies 60 4.4 The assessment of network heterogeneity and consistency 62 4.5 The results of component network meta-analysis 64 4.5.1 The results of additive model 64 4.5.2 The results of interactive model 67 4.6 The results of the heterogeneity of treatment efficacy 71 Chapter 5 Discussion 75 5.1 Treatment efficacy of glaucoma medications 75 5.1.1 The efficacy of different categories of monotherapies 77 5.1.2 The efficacy of the newly introduced glaucoma medications 77 5.1.3 The comparison of efficacy within the same class of monotherapies 83 5.1.4 The comparison of efficacy between different combination therapies 85 5.2 The interaction between glaucoma medications 91 5.2.1 The possible mechanism of drug-drug interaction 93 5.3 The heterogeneity of treatment efficacy 94 5.4 Strengths and limitations 97 5.5 Conclusion 103 Reference 106 Appendix I Search strategy 119 Appendix II List of included articles 123 Appendix III The summary of characteristics of studies included in the present network meta-analysis 142 | - |
| dc.language.iso | en | - |
| dc.subject | 元件網絡統合分析 | zh_TW |
| dc.subject | 網絡統合分析 | zh_TW |
| dc.subject | 眼壓 | zh_TW |
| dc.subject | 青光眼藥物 | zh_TW |
| dc.subject | 青光眼 | zh_TW |
| dc.subject | glaucoma | en |
| dc.subject | glaucoma medication | en |
| dc.subject | intraocular pressure | en |
| dc.subject | component network meta-analysis | en |
| dc.subject | network meta-analysis | en |
| dc.title | 單方暨複方青光眼藥物之降低眼壓效果與交互作用：系統性文獻回顧與網絡統合分析 | zh_TW |
| dc.title | Comparative efficacy and drug interaction of monotherapy and combination medication for primary open angle glaucoma: a systemic review and network meta-analysis | en |
| dc.type | Thesis | - |
| dc.date.schoolyear | 112-2 | - |
| dc.description.degree | 碩士 | - |
| dc.contributor.oralexamcommittee | 蕭朱杏;謝易庭 | zh_TW |
| dc.contributor.oralexamcommittee | Chu-Hsing Hsiao;Yi-Ting Hsieh | en |
| dc.subject.keyword | 網絡統合分析,元件網絡統合分析,青光眼,青光眼藥物,眼壓, | zh_TW |
| dc.subject.keyword | network meta-analysis,component network meta-analysis,glaucoma,glaucoma medication,intraocular pressure, | en |
| dc.relation.page | 150 | - |
| dc.identifier.doi | 10.6342/NTU202403561 | - |
| dc.rights.note | 未授權 | - |
| dc.date.accepted | 2024-08-07 | - |
| dc.contributor.author-college | 公共衛生學院 | - |
| dc.contributor.author-dept | 流行病學與預防醫學研究所 | - |
| 顯示於系所單位： | 流行病學與預防醫學研究所 | |
文件中的檔案：
| 檔案 | 大小 | 格式 | |
|---|---|---|---|
| ntu-112-2.pdf 未授權公開取用 | 3.31 MB | Adobe PDF |
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