Comparative efficacy and acceptability of pharmacological treatment in ischemic optic neuropathy: a multiple treatments meta-analysis

Background In traditional meta-analyses, ischemic optic neuropathy (ION) has been shown to be ineffective. The effects of all/10 drugs for the treatment of ION were assessed through a meta-analysis using direct and indirect comparisons of multiple treatments. Methods This systematic review of 9 randomized controlled trials (1012 participants) from April 1994 to May 2022 compared the efficacy of the following anti-ION drugs: placebo (PLA), ranibizumab (RAN), dexamethasone (DEX), prednisolone (PRE), oxygen (OX), troxerutin (TRO), RPh201, erythropoietin (ERY), levodopa + carbidopa (LEV+CAR), and prednisolone + ranitidine (PRE+RA). The primary measure of success was the percentage of patients who either responded to the treatment or discontinued the study. Intention-to-treat analysis was conducted. FindingsDEX, PRE, OX, TRO, ERY, LEV+CAR, and PRE+RA were significantly more effective than PLA (odds ratios 43.64, 1.19, 1.17, 4.22, 2.64, 3.32, and 1.10, respectively). RAN was significantly more effective than DEX (OR 1.67). RPh201 is significantly less effective than all other drugs. Acceptance of PLA was good. Overall,RAN and DEX are the best options for the treatment of ION. Therefore, these results should be considered in clinical practice.