Tacrolimus versus Cyclosporine- Comparative Evaluation as First line drug in Vernal keratoconjuctivitis

Abstract

Introduction: The aim of the study was to evaluate and compare the efficacy, side effects and recurrence rate of vernal kerato conjunctivitis (VKC) with 0.03% tacrolimus and 0.05% cyclosporin. Material and method: A prospective randomised double blinded comparative study was conducted at a tertiary eye center. 46 Patients of VKC between March 2015-August 2015 were randomly divided into two groups and treated for 6weeks with either Tacrolimus(0.03%) eye ointment BD or Cyclosporine (0.05%) eyedrops QID.The main outcome measures were scoring and comparison of Total subjective symptom scores (TSSS) and Total objective ocular sign scores (TOSS) within and between the Groups at each follow up.Thirty two patients, sixteen from each group, with comparable baseline characters were analysed. Results: With treatment both TSSS and TOSS decreased consistently in both groups without any adverse effects but an increase in scores was noticed within two weeks after drug withdrawal. Conclusion: Both drugs are equally effective and safe in VKC but with short lasting effect.

A comparative study of efficacy, tolerability and safety of 0.03% tacrolimus eye ointment and 0.05% cyclosporin eye drops in the treatment of vernal keratoconjunctivitis

“…It has been noted that all the patients have received treatment throughout the study period because of lower concentration of the medication used with negligible adverse effects resulting and good response. It has also been observed that patients on treatment with tacrolimus eye ointment 0.03% did not require any additional medications, which showed its potential role as steroid sparing agent which is in concurrence with the study done by Kumar S et al [7] In this study, both the drugs (cyclosporine eye drops 0.05% and tacrolimus eye ointment 0.03%) were almost equally efficacious (97% and 100% respectively) in treating VKC and did not show any significant difference between their ~ 32 ~ efficacy, which concurs with a similar prospective double masked, randomized comparative study done by Kumari R et al in 2016 in which tacrolimus eye ointment 0.03% brought about an improvement of the signs and symptoms of VKC similar to cyclosporine eye drops [12] . Also, there were no ocular side effects in either group which is in concordance with the study done by Singla E et al [13] IOP, lens and fundus of all the patients were with in normal limits throughout the study period in both groups, which concurs with studies done by Kumari R et al and Singla E et al [12][13] The results of this study are in concurrence with another prospective double-masked, randomized, comparative study conducted in 2016 by Kumari R and Saha CB in which 19 patients received tacrolimus eye ointment 0.03% daily for 6 weeks and another 15 received cyclosporine eye drops 0.5% four times daily for 6 weeks, where it was found that tacrolimus brought about an improvement of the signs and symptoms of VKC similar to that of cyclosporine A [12] .…”

Therapeutic efficacy of tacrolimus in vernal keratoconjunctivitis: a meta-analysis of randomised controlled trials

“…Five articles were eventually included after the screening based on the established inclusion and exclusion criteria. [12][13][14][15][16] Figure 1 shows the flow chart of literature screening from this meta-analysis.…”

“…3The TAC treatment duration varied across different studies as well. For instance, one study treated the patients with TAC for up to 6 weeks, 15 while another study treated the patients for just 1 week. 16 (4) The baseline scores of objective signs and baseline scores of subjective symptoms between the five included studies were also different.…”

“…For example, the average scores of objective signs were higher than 15 points in two studies, 12 16 lower than 9 points in another two studies, 13 14 and even lower than 5 points in the remaining study. 15 This study had some limitations: (1) the number of included studies was small, thus requiring caution in the interpretation of results; (2) the sample size involved in the included studies was also small, which was prone to bias; (3) the analysis of patient objective signs and subjective symptoms after TAC treatment showed high heterogeneity in the merged literature data, thereby reducing the reliability of the analysis-accordingly, further research will be needed to verify the findings of this study; (4) given the small amount of literature included in the present study, no subgroup analysis of the causes of high heterogeneity was performed.…”

A Double-Masked Comparison Of 0.1% Tacrolimus Ointment And 2% Cyclosporine Eye Drops As First Line Drugs in the Treatment of Vernal Keratoconjunctivitis

“…In our study both 0.1% Tacrolimus and 2% Cyclosporine cause a reduction in TSSS from 4 th week onwards. A similar prospective, double-masked, randomized comparative study was conducted by Rashmi kumara et al (33) in 2016 in which 19 patients received 0.03%Tacrolimus eye ointment daily for 6 weeks and other 15 recieved 0.05% Cyclosporine eye drops four times daily for 6 weeks. This study reported that tacrolimus brought about an improvement of the signs and symptoms of VKC similar to that of cyclosporine A.…”