Brinzolamide/timolol shows modest advantage in morning IOP reduction over dorzolamide/timolol

Brinzolamide/timolol (BT) lowers morning intraocular pressure (IOP) in patients with glaucoma slightly more than dorzolamide/timolol (DT), but the difference is modest, according to a study.

The systematic review and meta-analysis of 12 studies included 11 randomized controlled trials and 1,885 patients.

Brinzolamide/timolol achieved a statistically greater reduction in morning IOP compared with DT at 12 weeks or longer, with a mean difference of 0.56 mmHg (P < 0.001). In the brinzolamide/timolol fixed-combination (BTFC) subgroup, the mean difference was 0.66 mmHg (P < 0.001). Similar advantages for BT were observed at 8 and 4 weeks. However, there was no significant difference between the treatments in evening IOP reduction.

Brinzolamide/timolol was associated with a 49% lower risk of eye irritation compared with DT (P < 0.001). However, it carried a threefold higher risk of blurred vision (P < 0.001). Studies evaluating patient preference favored the brinzolamide/timolol fixed combination, citing reduced ocular discomfort.

The authors noted that although BT demonstrated a statistically greater reduction in morning IOP, the absolute difference was modest and its clinical significance remains uncertain. High heterogeneity in analyses of evening IOP and overall adverse events also limited interpretation. They concluded that treatment selection may depend on patient tolerance for ocular irritation with DT versus blurred vision with BT, and called for longer-term trials assessing 24-hour IOP control and patient preference.

Reference
Alamoudi A, Alnabihi A, Al-Qahtani S, et al. Comparative safety and efficacy of brinzolamide/timolol and dorzolamide/timolol in the treatment of glaucoma patients: A systematic review and meta-analysis. Eur J Ophthalmol. 2026;11206721261422832. doi: 10.1177/11206721261422832. Epub ahead of print. PMID: 41697795.