Long-term use of 0.003% tacrolimus suspension for treatment of vernal keratoconjunctivitis

Alamri, Abdulrahman; Fiorentini, Sandra Flavia; Albarry, Maan Abdullah; Bamahfouz, Ashjan

doi:10.4103/ojo.ojo_232_2014

Cited by 17 publications

(12 citation statements)

References 26 publications

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“…In Middle East, due to almost a year round warm weather, including very high temperatures of above 40-Celsius degrees in summer time, VKC is more prevalent and we suspected that the environment could play a role in delaying the patient’s response to Tacrolimus treatment. However, all the patients showed improvement at the same average time after initiation of Tacrolimus 0.03% treatment, as described in medical literature 23, 24, 25, 26, 27. Our case report series corroborate with literature regarding the time of action for the results to be achieved.…”

Section: Discussionsupporting

confidence: 63%

Therapeutic effects of topical 0.03% Tacrolimus ointment in children with refractory vernal keratoconjunctivitis in Middle East

Fiorentini

Khurram

2019

Saudi Journal of Ophthalmology

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Objective The purpose of this paper is to review the efficacy and safety profile in children treated with topical 0.03% Tacrolimus ointment for vernal keratoconjunctivitis in Middle East and to propose a treatment posology. According to recent studies, a complex non-IgE dependent mechanism plays a relevant role in the pathogenesis of vernal keratoconjunctivitis. Numerous cells and mediators have been found in the serum, conjunctiva and tears of patients with Vernal keratoconjunctivitis. Design This case series included 10 patients from a single centre, pediatric department of a tertiary hospital with active symptomatic vernal keratoconjunctivitis. All the patients had proliferative lesions and corneal involvement despite conventional medications, including topical steroids. All other medications, systemic and topical: steroids, antihistamines and cyclosporine, were unsuccessful. Patients were treated with topical 0.03% Tacrolimus ointment twice daily for 8 weeks and then once a day for the next two month followed by thrice a week for two months. The changes in symptoms and signs after treatment were evaluated, also the development of possible complications was assessed. Results The results showed a significant reduction in signs and symptoms after 4 weeks of the treatment. Clinical resolution of giant papillae and corneal lesions were seen within eight weeks and no additional drug was required during that period, except tear substitutes. Treatment was continued for period of two months and then slowly reduced. Conclusion The use of 0.03% Tacrolimus ointment is safe and effective in children refractory to conventional treatment of vernal keratoconjunctivitis even in high temperature climate as Middle East. Due to the effectiveness of the treatment, the dosage used may be proposed for conventional use.

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Section: Discussionsupporting

confidence: 63%

Therapeutic effects of topical 0.03% Tacrolimus ointment in children with refractory vernal keratoconjunctivitis in Middle East

Fiorentini

Khurram

2019

Saudi Journal of Ophthalmology

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Section: Methodsmentioning

confidence: 99%

“…Before starting treatment with tacrolimus and at each visit thereafter, all patients/guardians were given a questionnaire to grade all four symptoms into scale 0 (none), scale 1 or mild, scale 2 or moderate, and scale 3 or severe 11 . Similarly, clinical signs were also categorized by one observer into scale 0 (none), scale 1 (mild), scale 2 (moderate), or scale 3 (severe) in following way 11 . Total corneal surface More than half corneal surface Less than half corneal surface None Dermatological Tacrolimus ointment 0.03% was advised to be placed in inferior fornix in BD dose while all other conventional topical medications (antihistamine, mast cell stabilizers, NSAIDS) were discontinued except for steroids that were tapered off.…”

Section: Methodsmentioning

confidence: 99%

Efficacy of 0.03% Dermatological Tacrolimus Ointment for Refractory Vernal Keratoconjunctivitis.

Imtiaz

Qayyum²,

Iqbal³

et al. 2020

pak J Ophthalmol

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Purpose: To determine the efficacy of 0.03% dermatological tacrolimus ointment in patients with refractory vernal keratoconjunctivitis Study Design: Quasi-experimental study Study Place and Duration: Eye Department, DHQ-Teaching Hospital, Gujranwala, Pakistan from April 2018 to March 2019 Material and Methods: After approval from hospital ethical committee and obtaining written informed consent from each patient/guardian, patients of either gender between 4-16 years of age with VKC not responding to conventional treatment for more than 8 weeks or having steroid-induced complications were included in this study. Dermatological tacrolimus ointment 0.03% started to be placed in inferior fornix in BD frequency along with topical lubricants. Patients were followed up on a regular schedule. Individual symptoms score was assessed from the questionnaire and signs score from observer’s clinical assessment. Data were analyzed using SPSS v23.0. P-value <0.05 was considered as statistically significant. Results: 40 eyes of 20 patients were included in this study. Out of which 4(20%) were female and 16 were male (80%). Mean baseline score for clinical symptoms was 6.65±1.81 that reduced to 1.65±0.81 after 12 weeks treatment course of tacrolimus with a significant p-value of 0.006 (p<0.05). Mean baseline score for clinical signs was 5.9±1.59 that improved to 1.80±0.83 after 12 weeks treatment course with a statistically significant p-value of 0.003 (p<0.05). Conclusions: In conclusion, topical tacrolimus dermatological ointment 0.03% is highly effective in refractory VKC and can be safely used as an alternative in VKC patients who are steroid-responders.

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“…Moderate to severe types of VKC can be treated mainly with topical steroids, but not for a long time (3,4). Recently, topical immune-modulatory medications including cyclosporine and tacrolimus (TAC) eye drops have been used for its treatment (5)(6)(7)(8)(9)(10). Furthermore, steroid dependency is a frequent finding in these patients, who make them prone to steroid-induced complications including cataract, glaucoma especially in children aged less than 10 years, and infectious diseases.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, finding the ways including high potency steroid sparing medications, which subside their chronic inflammation and decrease their dependency to steroids might potentially reduce their visual impairment and drug-induced complications (13)(14)(15). The calcineurin-inhibitor of TAC impedes the activation of T-lymphocytes, with a prophylactic effect for organ rejection in patients with transplant surgery (16,17). The topical TAC as a strong immunosuppressant is extensively prescribed to inhibit transplant rejection of organs like kidney and liver.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Topical Tacrolimus 0.05% Suspension in Steroid-Resistant and Steroid-Dependent Vernal Keratoconjunctivitis

Akbari¹

2021

PJMHS

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Objective: The purpose of this study was to investigate the safety and effectiveness of topical tacrolimus 0.05% suspension in the management of prolonged steroid-dependent and -resistant vernal keratoconjunctivitis (VKC). Materials and methods: The present interventional prospective case series were conducted on the research units suffering from refractory VKC between 2017, April and 2020, December. Despite routine drug treatment, consisting of topical steroids (steroid-resistant group), all subjects exhibited active symptomatic illness or were dependent on topical steroids (steroid-dependent group). After discontinuation of all medications for at least 1 week, the patients received eye drop (topical tacrolimus 0.05%) minimally for six months. Objective and subjective signs and symptoms were examined for alterations after one week, and one and six months of treatment. Analyses were continued for probable systemic and ocular adverse effects. Results: The study included 28 eyes of 14 participants (including 4 females and 10 males), with the mean age of 22 ± 8 years (between 11 and 38 years), and the mean VKC duration of 12 ± 6 years (between 5 and 23 years), as well as follow up period of 10±2 months (between 6 and 12 months). The results showed an improvement (P<0.001) in the symptoms such as mucus discharge, foreign body sensation, photosensitivity, redness, burning and itching. The initial sign was conjunctival hyperemia, which improved one week after treatment. Other objective signs including, conjunctival and limbal papillary hypertrophy, corneal pannus and corneal punctate epithelial erosions improved at least one month after treatment. No changes were observed in corneal opacity during follow-up (p> 0.05). There were no systemic or ocular adverse effects. Conclusion: This is the first time that tacrolimus suspension drops 0.05%, are used in these cases. Topical tacrolimus 0.05% was shown to be an effectiveness and safe agent to treat the refractory VKC. This drug is recommended to be prescribed prior to the appearance of side effects such as corneal opacity, irreversible deficiency in limbal stem cell, and steroid side effects. Keywords: Vernal keratoconjunctivitis, Tacrolimus eye drop, Refractory

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Long-term use of 0.003% tacrolimus suspension for treatment of vernal keratoconjunctivitis

Cited by 17 publications

References 26 publications

Therapeutic effects of topical 0.03% Tacrolimus ointment in children with refractory vernal keratoconjunctivitis in Middle East

Therapeutic effects of topical 0.03% Tacrolimus ointment in children with refractory vernal keratoconjunctivitis in Middle East

Efficacy of 0.03% Dermatological Tacrolimus Ointment for Refractory Vernal Keratoconjunctivitis.

Efficacy of Topical Tacrolimus 0.05% Suspension in Steroid-Resistant and Steroid-Dependent Vernal Keratoconjunctivitis

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