Abstract
Purpose :
Cationic 0.1% cyclosporine A eye drops (c-CsA), the commercially available form of topical application of cyclosporine A (CsA) in Europe, is a frequently used long-term treatment option to control ocular surface inflammation in patients (pat.) suffering from chronic ocular graft-versus-host disease (GvHD). However, low tolerance (stinging, burning sensation, itching, redness of the eye) reduces treatment adherence. Other drug delivery systems for topical CsA – such as liposomes – are being evaluated as alternatives for c-CsA, yet information regarding clinical usage remains scarce. Therefore, we conducted a retrospective analysis to investigate how pat. responded to a switch from c-CsA to liposomal CsA eye drops (l-CsA).
Methods :
We reviewed medical charts of 24 pat. with chronic ocular GvHD (m:f = 18:6, mean age = 61.7 ± 12.6 years) who received l-CsA as an alternative to c-CsA. L-CsA was topically administered in concentrations of 0.5%, 1.0%, and 2.0% (n = 8, 11, 5 pat., respectively). Pat. documentation was examined for any mentions of improved tolerance to or symptom amelioration after switching to l-CsA. When documented, ocular surface disease index (OSDI) was compared before and after CsA switch. Paired samples t-test was used for statistical analysis.
Results :
C-CsA was switched to l-CsA either due to intolerance (n = 11 pat./46%) or insufficient therapeutic effect (n = 13 pat./54%). Mean follow-up time was 13.1 ± 6.6 weeks. Among the pat. who discontinued c-CsA due to intolerance, 7 reported better tolerance for l-CsA than for the former medication (64%). Only two pat. – treated with 2.0% l-CsA – voiced discomfort to the same degree as with c-CsA. In the group of pat. who discontinued c-CsA due to lack of efficacy, 9 expressed reduced symptoms after switching to l-CsA (69%).
OSDI was reduced significantly from 52.4 ± 29.7 before to 30.3 ± 19.5 after treatment switch (p = 0.047).
Conclusions :
L-CsA appears to be an effective and often better-tolerated alternative to c-CsA, particularly among pat. with ocular GvHD who experience intolerance or even need to discontinue c-CsA due to side effects. Since other studies revealed higher rates of intolerance to c-CsA in GvHD pat. compared to those with dry eye disease, higher tolerability and effectiveness of alternative CsA formulations – like l-CSA – are needed especially in this particular pat. group.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.