Tacrolimus vs. cyclosporine eyedrops in severe cyclosporine‐resistant vernal keratoconjunctivitis: A randomized, comparative, double‐blind, crossover study

Pucci, Neri; Caputo, Roberto; Grande, Laura Di; Libero, Cinzia de; Mori, Francesca; Barni, Simona; Simone, L Di; Calvani, Annamaria; Rusconi, Franca; Novembre, Elio

doi:10.1111/pai.12360

Cited by 57 publications

(69 citation statements)

References 22 publications

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“…A RCT comparing the effect of tacrolimus 0.1% vs CsA 2% showed that both drugs were effective in treating VKC without significant differences between the two. In a second RCT, CsA‐resistant VKC patients, treated with tacrolimus 0.1%, showed a significant improvement in clinical scores over CsA 1%. A recent trial comparing the effect of 0.1% topical tacrolimus alone or in combination with topical corticosteroids in refractory allergic ocular diseases also showed a potential steroid‐sparing effect .…”

Section: Resultsmentioning

confidence: 95%

Management of ocular allergy

Leonardi

Silva

Formigo

et al. 2019

Allergy

107

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Funding informationThis work was done under the approval of EAACI with a TF budget 2015-18. AbstractThe treatment and management of ocular allergy (OA) remain a major concern for different specialties, including allergists, ophthalmologists, primary care physicians, rhinologists, pediatricians, dermatologists, clinical immunologists, and pharmacists.We performed a systematic review of all relevant publications in MEDLINE, Scopus, and Web Science including systematic reviews and meta-analysis. Publications were considered relevant if they addressed treatments, or management strategies of OA.A further wider systematic literature search was performed if no evidence or good quality evidence was found. There are effective drugs for the treatment of OA; however, there is a lack an optimal treatment for the perennial and severe forms. Topical antihistamines, mast cell stabilizers, or double-action drugs are the first choice of treatment. All of them are effective in reducing signs and symptoms of OA. The safety and optimal dosing regimen of the most effective topical anti-inflammatory drugs, corticosteroids, are still a major concern. Topical calcineurin inhibitors may be used in steroid-dependent/resistant cases of severe allergic keratoconjunctivitis.Allergen-specific immunotherapy may be considered in cases of failure of first-line treatments or to modify the natural course of OA disease. Based on the current wealth of publications and on the collective experience, recommendations on management of OA have been proposed.

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Section: Resultsmentioning

confidence: 95%

Management of ocular allergy

Leonardi

Silva

Formigo

et al. 2019

Allergy

107

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“…Tacrolimus, derived from the bacterium Streptomyces tsukubaensis, like cyclosporine, is a calcineurin inhibitor in the immune mechanism but with a 100-fold-greater potency [12]. It suppresses Th2 lymphocyte activation, Th cell-mediated B cell proliferation, and the formation of cytokines.…”

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confidence: 99%

Therapeutic Effect of 0.1% Tacrolimus Eye Drops in the Tarsal Form of Vernal Keratoconjunctivitis

Wan¹,

Tang²,

Han³

et al. 2017

Ophthalmic Res

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Objective: The purpose of this study was to evaluate the efficacy and safety of 0.1% tacrolimus eye drops in the tarsal form of vernal keratoconjunctivitis (VKC) and to survey the changes of dendritic cells at the palpebral conjunctiva in patients with VKC by in vivo confocal microscopy. Methods: A total of 17 patients (34 eyes) with the tarsal form of VKC were enrolled in this prospective, nonrandomized case series. They were treated with 0.1% tacrolimus eye drops twice daily after discontinuation of all other topical medications. Subjective ocular symptoms and objective ocular signs were scored on a 4-point scale by one ophthalmologist and the characteristics of the dendritic cells in each right eye at the palpebral conjunctiva were evaluated by in vivo confocal microscopy before treatment and at the 1st, 2th, 4th, and 8th weeks after treatment. Results: After 1 week of treatment with 0.1% tacrolimus eye drops, the score for each symptom in all patients showed a significant (p < 0.001) improvement, and 13 patients (76%) experienced dramatic relief of symptoms. In addition, there was a significantly (p < 0.001) decreased clinical sign score (except for giant papillae) after 4 weeks, and a significant (p < 0.001) improvement in the score of giant papillae after 8 weeks of treatment. The characteristics of dendritic cells (including cell count, total area, average size, perimeter, and diameter) showed a significant (p < 0.05) decrease after 2 weeks of treatment. During the follow-up, no other topical medications were required and no significant changes in visual acuity were documented. No cataracts or elevation of intraocular pressures were detected. Only 5 patients (29%) had a tingling or burning sensation or discomfort. Conclusions: Tacrolimus 0.1% eye drops are an effective and safe treatment for the tarsal form of VKC, and can rapidly inhibit the activity of dendritic cells, improve symptoms, reduce papillary hyperplasia, and reverse damage at the palpebral conjunctiva. The side effects could affect the compliance of some patients.

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“…14 Pucci N et al, conducted studies using cyclosporine 1% and 2% concentrations15 in other study in 2015 they used 0.1% concentrations for patients who failed to respond to 1% Cyc eye drops. 16 Akpek EK et al, used 0.05% cyclosporine eye drops for treatment of severe steroid resistant vernal keratoconjunctivitis. 10…”

Section: Medicationsmentioning

confidence: 99%

A prospective study to compare the efficacy of tacrolimus vs cyclosporine in vernal keratoconjunctivitis in children in India

Choudhary¹,

Singh

Chaurasia

et al. 2019

Int J Basic Clin Pharmacol

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Background: Vernal keratoconjunctivitis (VKC) is a chronic allergic conjunctival disease. Immunomodulatory drugs like cyclosporine is being used for its treatment. Tacrolimus is another immunomodulator drug that can be used in VKC. This study was done to compare the efficacy of tacrolimus and cyclosporine in VKC.Methods: This prospective study was conducted on 60 patients of either sex by dividing them into two groups. The first group was treated with cyclosporine (0.05%) ophthalmic eye drop and second group with tacrolimus (0.03%) ophthalmic ointment. Total five objective signs (hyperaemia, oedema, papillae, corneal involvement and tantra’s dot) and five subjective symptoms (itching, tearing, foreign body sensation, discharge and photophobia) data was collected and tabulated for statistical analysis.Results: Authors found TSSS in both groups decrease significantly (p <0.05 or p <0.01 or p <0.001) at all post periods as compared to respective predecessor periods except 4 weeks to 6 weeks in cyclosporine group and 6 weeks to 8 weeks in tacrolimus group. Similarly, for each period, on comparing the mean TSSS between the groups TSSS between the groups at all periods does not differed statistically though at final evaluation (mean change from baseline to 8 weeks), it improved 5.2% more in tacrolimus group (83.7%) than cyclosporine group (78.5%). Similarly, TOSS also decreased at all post periods except 4 weeks to 6 weeks, and 6 weeks to 8 weeks in cyclosporine group and 6 weeks to 8 weeks in tacrolimus group. Improvement in scores was 11.6% more in tacrolimus (81.6%) than cyclosporine (70.0%). Cyclosporine eye drops are associated with burning sensation and redness of eyes while transient ocular irritation was only observed side effect with tacrolimus.Conclusions: The study found tacrolimus is clinically better drug for treatment of vernal keratoconjunctivitis than cyclosporine and is also cost effective.

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Tacrolimus vs. cyclosporine eyedrops in severe cyclosporine‐resistant vernal keratoconjunctivitis: A randomized, comparative, double‐blind, crossover study

Abstract: Topical Tcr is very effective and safe in the short term for patients suffering from severe VKC resistant to topical Cyc.

Cited by 57 publications

References 22 publications

Management of ocular allergy

Management of ocular allergy

Therapeutic Effect of 0.1% Tacrolimus Eye Drops in the Tarsal Form of Vernal Keratoconjunctivitis

A prospective study to compare the efficacy of tacrolimus vs cyclosporine in vernal keratoconjunctivitis in children in India

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