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. 2022 Jun 10;2022(6):CD013817. doi: 10.1002/14651858.CD013817.pub2

Summary of findings 2. Rho kinase inhibitor compared to beta‐blocker.

Population: people with primary open‐angle glaucoma or ocular hypertension
Settings: ophthalmology clinics
Intervention: netarsudil 0.02% once per day
Comparison: timolol 0.5% twice per day
Outcomes Illustrative absolute effect (or risk) * (95% CI) Risk difference (95% CI) No. of participants (RCTs) Certainty of the evidence (GRADE) Comments
Assumed risk 
with timolol
Corresponding risk with netarsudil
Glaucoma progression at 12 months, measured by additional visual field defects  
Not measured
Difference in mean IOP from baseline at < 6 months 4.60 mmHg lower (3.91 to 5.29) 3.94 mmHg lower (3.69 to 4.19) 0.66 mmHg higher (0.41 to 0.91) 1415 (3 RCTs) ⊕⊕⊝⊝
Lowa
Glaucoma progression at 12 months, defined by anatomic (structural) criteriab Not measured
Patient‐reported outcome at the longest follow‐up Not measured
Mean change in the number of glaucoma medications at the longest follow‐up Not measured
Need for additional treatment at the longest follow‐up  Not measured
Number of ocular adverse events at the longest follow‐up 9 events per 100 person‐months 30 events per 100 person‐months (23 to 36) 21 more events per 100 person‐months (14 to 27)  1678 (4 RCTs) ⊕⊕⊕⊝
Moderatec
BB: beta‐blocker; CI: confidence interval; IOP: intraocular pressure; RD: rate difference; ROKi: rho kinase inhibitor.
*The basis for the assumed effect (or risk) is the effect (or risk) in the Timolol group across studies. The corresponding effect (or risk and its 95% confidence interval) is based on the assumed risk in the comparison group and the difference in the effect (or risk) of the intervention (and its 95% CI).
GRADE Working Group grades of evidenceHigh certainty: further research is very unlikely to change our confidence in the estimate of effect.
Moderate certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low certainty: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low certainty: we are very uncertain about the estimate.

aDowngraded two levels for risk of bias: high risk of bias due to deviation from the intended intervention and missing outcome.
bAnatomic criteria may include thinning of neuroretinal rim at the optic disk, thinning of the peripapillary retinal nerve fiber layer, or thinning of the macular ganglion cell layer.
cDowngraded one level for risk of bias in incomplete outcome reporting or selective outcome reporting.