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2026, Vol: 10, Issue: 6
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Review Article
Online Published: 12 May 2026
 


Efficacy and safety of netarsudil compared with traditional prostaglandin analogs for intraocular pressure control in open angle glaucoma: a systematic review of randomized clinical trials (2020-2025)

Sabah Mubarak H. Alshahrani, Sulaiman Altraiqi, Shaima Yahya A. Assiri, Lamya Mohammed S. Almobty, Basmah Durizi K. Alrawaili, Abdulhamid Hamoud Altowairqi, Tahani Srihan Alzahrani, Dina Adnan O. Yamani.


Abstract
This systematic review evaluated the efficacy and safety of netarsudil compared to traditional prostaglandin analogs (PGAs) for intraocular pressure (IOP) control in open-angle glaucoma, synthesizing evidence from randomized clinical trials published between 2020 and 2025. A comprehensive literature search of PubMed, Web of Science, and Google Scholar yielded 10 randomized controlled trials meeting the inclusion criteria. The findings demonstrated that netarsudil effectively reduces IOP, though PGA monotherapy generally achieves greater mean reductions. The fixed-dose combination of netarsudil and latanoprost consistently provided superior IOP lowering compared to either agent alone, suggesting an additive or synergistic effect. Regarding safety, netarsudil was associated with a higher incidence of ocular adverse events, predominantly mild-to-moderate conjunctival hyperemia, subconjunctival hemorrhage, and corneal verticillata, while PGAs demonstrated their known profile of hyperemia, iris pigmentation changes, and eyelash growth. No serious treatment-related adverse events were reported across the included trials. Risk of bias assessment using the Cochrane Risk of Bias 2 tool identified four studies with low risk, two with some concerns, and four with high risk, primarily due to missing outcome data or limitations in randomization. In conclusion, while prostaglandin analogs remain more potent as monotherapy, netarsudil represents a valuable adjunctive option, particularly for patients requiring additional IOP lowering or those with suboptimal response or intolerance to first-line PGA therapy. Careful patient counseling regarding the higher likelihood of conjunctival hyperemia is warranted to optimize adherence and treatment success.

Key words: Open-angle glaucoma, netarsudil, prostaglandin analogs, intraocular pressure, Rho kinase inhibitors


 
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How to Cite this Article
Pubmed Style

Alshahrani SMH, Altraiqi S, Assiri SYA, Almobty LMS, Alrawaili BDK, Altowairqi AH, Alzahrani TS, Yamani DAO. Efficacy and safety of netarsudil compared with traditional prostaglandin analogs for intraocular pressure control in open angle glaucoma: a systematic review of randomized clinical trials (2020-2025). IJMDC. 2026; 10(6): 1651-1657. doi:10.24911/IJMDC.51-1769772847

Web Style

Alshahrani SMH, Altraiqi S, Assiri SYA, Almobty LMS, Alrawaili BDK, Altowairqi AH, Alzahrani TS, Yamani DAO. Efficacy and safety of netarsudil compared with traditional prostaglandin analogs for intraocular pressure control in open angle glaucoma: a systematic review of randomized clinical trials (2020-2025). https://www.ijmdc.com/?mno=308620 [Access: June 29, 2026]. doi:10.24911/IJMDC.51-1769772847

AMA (American Medical Association) Style

Alshahrani SMH, Altraiqi S, Assiri SYA, Almobty LMS, Alrawaili BDK, Altowairqi AH, Alzahrani TS, Yamani DAO. Efficacy and safety of netarsudil compared with traditional prostaglandin analogs for intraocular pressure control in open angle glaucoma: a systematic review of randomized clinical trials (2020-2025). IJMDC. 2026; 10(6): 1651-1657. doi:10.24911/IJMDC.51-1769772847


Vancouver/ICMJE Style

Alshahrani SMH, Altraiqi S, Assiri SYA, Almobty LMS, Alrawaili BDK, Altowairqi AH, Alzahrani TS, Yamani DAO. Efficacy and safety of netarsudil compared with traditional prostaglandin analogs for intraocular pressure control in open angle glaucoma: a systematic review of randomized clinical trials (2020-2025). IJMDC. (2026), [cited June 29, 2026]; 10(6): 1651-1657. doi:10.24911/IJMDC.51-1769772847


Harvard Style

Alshahrani, S. M. H., Altraiqi, . S., Assiri, . S. Y. A., Almobty, . L. M. S., Alrawaili, . B. D. K., Altowairqi, . A. H., Alzahrani, . T. S. & Yamani, . D. A. O. (2026) Efficacy and safety of netarsudil compared with traditional prostaglandin analogs for intraocular pressure control in open angle glaucoma: a systematic review of randomized clinical trials (2020-2025). IJMDC, 10 (6), 1651-1657. doi:10.24911/IJMDC.51-1769772847


Turabian Style

Alshahrani, Sabah Mubarak H., Sulaiman Altraiqi, Shaima Yahya A. Assiri, Lamya Mohammed S. Almobty, Basmah Durizi K. Alrawaili, Abdulhamid Hamoud Altowairqi, Tahani Srihan Alzahrani, and Dina Adnan O. Yamani. 2026. Efficacy and safety of netarsudil compared with traditional prostaglandin analogs for intraocular pressure control in open angle glaucoma: a systematic review of randomized clinical trials (2020-2025). International Journal of Medicine in Developing Countries, 10 (6), 1651-1657. doi:10.24911/IJMDC.51-1769772847


Chicago Style

Alshahrani, Sabah Mubarak H., Sulaiman Altraiqi, Shaima Yahya A. Assiri, Lamya Mohammed S. Almobty, Basmah Durizi K. Alrawaili, Abdulhamid Hamoud Altowairqi, Tahani Srihan Alzahrani, and Dina Adnan O. Yamani. "Efficacy and safety of netarsudil compared with traditional prostaglandin analogs for intraocular pressure control in open angle glaucoma: a systematic review of randomized clinical trials (2020-2025)." International Journal of Medicine in Developing Countries 10 (2026), 1651-1657. doi:10.24911/IJMDC.51-1769772847


MLA (The Modern Language Association) Style

Alshahrani, Sabah Mubarak H., Sulaiman Altraiqi, Shaima Yahya A. Assiri, Lamya Mohammed S. Almobty, Basmah Durizi K. Alrawaili, Abdulhamid Hamoud Altowairqi, Tahani Srihan Alzahrani, and Dina Adnan O. Yamani. "Efficacy and safety of netarsudil compared with traditional prostaglandin analogs for intraocular pressure control in open angle glaucoma: a systematic review of randomized clinical trials (2020-2025)." International Journal of Medicine in Developing Countries 10.6 (2026), 1651-1657. Print. doi:10.24911/IJMDC.51-1769772847


APA (American Psychological Association) Style

Alshahrani, S. M. H., Altraiqi, . S., Assiri, . S. Y. A., Almobty, . L. M. S., Alrawaili, . B. D. K., Altowairqi, . A. H., Alzahrani, . T. S. & Yamani, . D. A. O. (2026) Efficacy and safety of netarsudil compared with traditional prostaglandin analogs for intraocular pressure control in open angle glaucoma: a systematic review of randomized clinical trials (2020-2025). International Journal of Medicine in Developing Countries, 10 (6), 1651-1657. doi:10.24911/IJMDC.51-1769772847




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