Reducing Adenoviral Patient-Infected Days (RAPID) Study: A Randomized Trial Assessing Efficacy of One Time, In-Office Application of 5% Povidone-Iodine in Treatment of Adenoviral Conjunctivitis

Abstract

Purpose : To report results of a double-masked pilot clinical trial of 5% povidone-iodine (PVP-I) for treatment of adenoviral conjunctivitis (Ad-Cs).

Methods : Patients with presumed Ad-Cs were screened at 9 centers. Inclusion criteria were a positive AdenoPlus^TM (Quidel, San Diego CA) immunoassay, age ≥ 18 and symptom onset ≤ 4 days. Of 212 patients screened, 56 were eligible and randomized to a single, in-office administration of either 5% PVP-I or artificial tears (AT). Follow-up visits were at days 1-2, 4, 7, 14 and 21. At each visit, a masked clinician graded clinical signs, administered a 10-symptom survey, and obtained a conjunctival swab sample. Samples were analyzed using an adenovirus-specific primer set and an Integrated qPCR Cycler (DiaSorin Molecular, Cypress CA).

Results : Of the 56 randomized participants who tested positive with the AdenoPlus at the eligibility visit, only 50% (28/56) were confirmed positive for Ad-Cs by qPCR. Of the 28 qPCR+ participants, 16 received 5% PVP-I and 12 received AT. Baseline viral titers were 14.8 ± 3.5 SD log DNA copies/ml in the PVP-I group and 14.6 ± 2.8 in the AT group (p=0.91, Wilcoxon). At day 4: 1) log titers were 8.9 ± 5.9 in the PVP-I group and 13.4 ± 2.6 in the AT group (p=0.08); 2) participant-reported tearing, eyelid swelling and redness significantly improved in the PVP-I group compared to the AT group (p<0.05), with eyelash matting (p=0.05) and overall discomfort (p=0.07) showing similar trends ; 3) clinician-graded mucoid discharge, bulbar redness, bulbar edema and follicular response were significantly lower in the PVP-I group compared to the AT group (p<0.05). There were no significant differences between the groups in viral titers, symptoms or signs at days 1-2, 7, 14 nor 21. In qPCR- participants, there was no benefit from 5% PVP-I on the outcome measures at any visit with the exception of clinician-graded eyelid matting on days 1-2.

Conclusions : Among participants testing positive for Ad-Cs by qPCR, those receiving a one time, in-office application of 5% PVP-I showed improvement in signs and symptoms and lower viral titers at day 4 compared to participants who received AT. There was no benefit of 5% PVP-I in participants who tested negative for Ad-Cs by qPCR at the same time-point.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.