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Bourcier T, Dory A, Dormegny L, Alcazar J, Gaucher D, Sauer A. Efficacy and Safety of 0.1% Cyclosporine versus 2% Cyclosporine in the Treatment of Severe Vernal Keratoconjunctivitis in Children. Clin Ophthalmol 2022; 16:3589-3596. [PMID: 36304991 PMCID: PMC9596278 DOI: 10.2147/opth.s370414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Vernal keratoconjunctivitis (VKC) is an inflammatory condition in children that can cause severe eye complications. Treatment is based on corticosteroid therapy during flare-ups, then antihistamines and cyclosporine in calmer periods. The dosage and posology of cyclosporine are subject to debate. METHODS The aim of the study is to compare the evolution in symptomatic and clinical scores, and need for topical corticosteroid treatment in a population of children with severe VKC treated with two dosages of cyclosporine treatment (0.1% and 2%). Data were compiled on inclusion then every three months from March, with a total follow-up duration of 12 months. Data concerning patient evolutions and complications were collected for the two treatment groups. RESULTS The mean age of the 46 children was 8.8 ±2.4 years with age at onset of symptoms of 5.1 ± 0.9 years. The cohort was predominantly (65%) male. Corticosteroid dependence on inclusion was present in 52% of the children included. A significant improvement in the various symptomatic and clinical scores was observed following treatment with cyclosporine (0.1% and 2%). Use of topical corticosteroid treatment reduced from 19 drops per month on inclusion to 4 drops per month at 12 months. Safety was comparable for the two groups. CONCLUSION Treatments with cyclosporine 0.1% and 2% lead to a favourable evolution in clinical and symptomatic scores and reduced corticosteroid use. Cyclosporine 0.1% is an interesting alternative to the 2% dosage, particularly due to its availability and ease of handling.
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Affiliation(s)
- Tristan Bourcier
- Department of Ophthalmology, Strasbourg University Hospital, University of Strasbourg, Strasbourg, France
| | - Anne Dory
- Pharmacy, Strasbourg University Hospital, University of Strasbourg, Strasbourg, France
| | - Lea Dormegny
- Department of Ophthalmology, Strasbourg University Hospital, University of Strasbourg, Strasbourg, France
| | - Joffrey Alcazar
- Department of Ophthalmology, Strasbourg University Hospital, University of Strasbourg, Strasbourg, France
| | - David Gaucher
- Department of Ophthalmology, Strasbourg University Hospital, University of Strasbourg, Strasbourg, France
| | - Arnaud Sauer
- Department of Ophthalmology, Strasbourg University Hospital, University of Strasbourg, Strasbourg, France,Correspondence: Arnaud Sauer, Department of Ophthalmology, Nouvel Hôpital Civil, Strasbourg University Hospital, BP426, Strasbourg, 67091, France, Email
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Executive summary: Japanese guidelines for allergic conjunctival diseases 2021. Allergol Int 2022; 71:459-471. [PMID: 36096976 DOI: 10.1016/j.alit.2022.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
Allergic conjunctival disease (ACD) is an inflammatory disease of the conjunctiva that is mainly caused by type I hypersensitivity response to allergens and accompanied by subjective symptoms and other findings induced by antigens. ACD is classified as allergic conjunctivitis, atopic keratoconjunctivitis, vernal keratoconjunctivitis, and giant papillary conjunctivitis. This article summarizes the third edition of the Japanese guidelines for allergic conjunctival diseases published in 2021 and outlines the diagnosis, pathogenesis, and treatment of ACD. Since the introduction of immunosuppressive eye drops, the treatment strategies for severe ACDs have significantly changed. To clarify the recommended standard treatment protocols for ACD, the advantages and disadvantages of these treatments were assessed using clinical questions, with a focus on the use of steroids and immunosuppressive drugs. This knowledge will assist healthcare providers and patients in taking an active role in medical decision making.
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Bernales A, Berger O, Hamada S. Topical tacrolimus for the treatment of external eye inflammation in children. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2039628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Osvaldo Berger
- Corneoplastic department. Queen Victoria Hospital. East Grinstead. United Kingdom
| | - Samer Hamada
- Corneoplastic department. Queen Victoria Hospital. East Grinstead. United Kingdom
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Zhao M, He F, Yang Y, Lin W, Qiu W, Meng Q, Zhang J, Zhou Z. Therapeutic efficacy of tacrolimus in vernal keratoconjunctivitis: a meta-analysis of randomised controlled trials. Eur J Hosp Pharm 2020; 29:129-133. [PMID: 33144336 PMCID: PMC9047954 DOI: 10.1136/ejhpharm-2020-002447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/27/2020] [Accepted: 10/05/2020] [Indexed: 12/26/2022] Open
Abstract
Background and objective Tacrolimus has been widely used in recent years for treating allergic conjunctivitis, but there is currently no available meta-analysis regarding its therapeutic efficacy. This study systematically evaluated the effectiveness of tacrolimus in the treatment of allergic conjunctivitis. Methods Data obtained from literature searches of the PubMed, Cochrane Library, Embase, CNKI, and Wanfang databases were retrieved by combining medical subject words and free words. Literature was selected on the basis of established inclusion and exclusion criteria, and the extracted data were evaluated for risk of bias using RevMan 5.3 for meta-analysis. Results A total of 177 articles were retrieved, of which 5 articles were eventually selected, all of which involved tacrolimus treatment for vernal keratoconjunctivitis. A total of 203 samples were analysed. Results of the meta-analysis showed that the tacrolimus treatment group had significantly lower ocular objective sign scores (SMD −1.39, 95% CI −2.50 to −0.27; p<0.05) and had a significantly lower subjective symptom evaluation score (SMD −0.92, 95% CI −1.59 to −0.24; p<0.05) than the control group. Conclusion Current evidence shows that tacrolimus is effective in treating vernal keratoconjunctivitis.
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Affiliation(s)
- Min Zhao
- Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai 519000, China.,College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Fazhong He
- Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai 519000, China
| | - Yang Yang
- Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai 519000, China
| | - Weijie Lin
- Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai 519000, China
| | - Wentao Qiu
- Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai 519000, China.,College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Qian Meng
- Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai 519000, China
| | - Jianping Zhang
- College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Zhiling Zhou
- Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai 519000, China
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Abstract
PURPOSE OF REVIEW The purpose of this article is to review treatment advances in ocular allergy that include the treatment of the various signs and symptoms of the allergic inflammatory response of the ocular surface. RECENT FINDINGS Recent studies have demonstrated improved pharmacological effect of topical agents with artificial tears and cold compresses; brimonidine, a new ophthalmic decongestant which has demonstrated decreased rebound conjunctivitis; and potential use of contact lens and other novel delivery instruments to increase medication retention time. Currently, there have been limited advances in novel ophthalmic treatments. Non-pharmacological interventions have demonstrated in a randomized control study that artificial tears and the use cold compresses alone or in combination with ophthalmic antihistamines can enhance the effectiveness of a traditional pharmacological therapy. The primary advances have been the start of head-to-head studies comparing various agents actively being used in the treatment of ocular allergy. In addition, there has been increasing interest in the development of novel delivery systems to increase residence time of pharmacological agents in the ocular surface such as nanoparticles, microfilms; examining novel pathways of controlling the allergic inflammatory response of the ocular surface such as modulation of cytokines, transcription factors, and immunophilins.
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Affiliation(s)
- Leonard Bielory
- Department of Medicine and Ophthalmology, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, USA.
- Department of Medicine, Thomas Jefferson University Sidney Kimmel School of Medicine, Philadelphia, PA, USA.
- Rutgers University Center of Environmental Prediction, New Brunswick, NJ, USA.
- , Springfield, USA.
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The Immunosuppressant Macrolide Tacrolimus Activates Cold-Sensing TRPM8 Channels. J Neurosci 2018; 39:949-969. [PMID: 30545944 DOI: 10.1523/jneurosci.1726-18.2018] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/02/2018] [Accepted: 11/18/2018] [Indexed: 12/30/2022] Open
Abstract
TRPM8 is a polymodal, nonselective cation channel activated by cold temperature and cooling agents that plays a critical role in the detection of environmental cold. We found that TRPM8 is a pharmacological target of tacrolimus (FK506), a macrolide immunosuppressant with several clinical uses, including the treatment of organ rejection following transplants, treatment of atopic dermatitis, and dry eye disease. Tacrolimus is an inhibitor of the phosphatase calcineurin, an action shared with cyclosporine. Tacrolimus activates TRPM8 channels in different species, including humans, and sensitizes their response to cold temperature by inducing a leftward shift in the voltage-dependent activation curve. The effects of tacrolimus on purified TRPM8 in lipid bilayers demonstrates conclusively that it has a direct gating effect. Moreover, the lack of effect of cyclosporine rules out the canonical signaling pathway involving the phosphatase calcineurin. Menthol (TRPM8-Y745H)- and icilin (TRPM8-N799A)-insensitive mutants were also activated by tacrolimus, suggesting a different binding site. In cultured mouse DRG neurons, tacrolimus evokes an increase in intracellular calcium almost exclusively in cold-sensitive neurons, and these responses were drastically blunted in Trpm8 KO mice or after the application of TRPM8 antagonists. Cutaneous and corneal cold thermoreceptor endings are also activated by tacrolimus, and tacrolimus solutions trigger blinking and cold-evoked behaviors. Together, our results identify TRPM8 channels in sensory neurons as molecular targets of the immunosuppressant tacrolimus. The actions of tacrolimus on TRPM8 resemble those of menthol but likely involve interactions with other channel residues.SIGNIFICANCE STATEMENT TRPM8 is a polymodal TRP channel involved in cold temperature sensing, thermoregulation, and cold pain. TRPM8 is also involved in the pathophysiology of dry eye disease, and TRPM8 activation has antiallodynic and antipruritic effects, making it a prime therapeutic target in several cutaneous and neural diseases. We report the direct agonist effect of tacrolimus, a potent natural immunosuppressant with multiple clinical applications, on TRPM8 activity. This interaction represents a novel neuroimmune interface. The identification of a clinically approved drug with agonist activity on TRPM8 channels could be used experimentally to probe the function of TRPM8 in humans. Our findings may explain some of the sensory and anti-inflammatory effects described for this drug in the skin and the eye surface.
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Pimecrolimus micelle exhibits excellent therapeutic effect for Keratoconjunctivitis Sicca. Colloids Surf B Biointerfaces 2016; 140:1-10. [DOI: 10.1016/j.colsurfb.2015.11.059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 11/03/2015] [Accepted: 11/27/2015] [Indexed: 12/25/2022]
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Gomes P, Slocum C, Smith LM, Abelson MB. Challenges faced in clinical trials for chronic allergic conjunctivitis. EXPERT REVIEW OF OPHTHALMOLOGY 2015. [DOI: 10.1586/17469899.2015.1081563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Viveiros MMH, Kakizaki FY, Hércules LA, Padovani CR, Candeias JMG, Schellini SA. In vitro study of cyclosporine A 0.05 % on primary and recurrent pterygium fibroblasts. Int Ophthalmol 2015; 36:237-42. [PMID: 26260358 DOI: 10.1007/s10792-015-0106-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 07/30/2015] [Indexed: 02/06/2023]
Abstract
To compare the cyclosporine 0.05 % exposure effect on fibroblasts from primary and recurrent pterygium. Primary culture of fibroblasts from primary and recurrent pterygium was performed until the third passage, which was exposed to cyclosporine 0.05 % in a group and the other remaining unexposed (control group), in triplicates. After 3, 6, 12, and 17 days of exposure the viable cell counting was performed by hemocytometer. The results were statistically analyzed using the technique of analysis of non-parametric variance model for repeated measures with three factors. There was a significant reduction in both fibroblast proliferation, in primary as in the recurrent pterygium cultures exposed to cyclosporine when compared not exposed cultures, with statistical significance (P < 0.05). Comparing primary and recurrent pterygium that received the drug, there was no significant difference in cell proliferation in relation to primary or recurrent pterygium. Cyclosporine 0.05 % is effective in inhibiting fibroblast proliferation in culture, both in primary and as in recurrent pterygium.
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Affiliation(s)
- Magda Massae Hata Viveiros
- Post-Doctoral of the General Basis of Surgery Post Graduation Program of Botucatu Medical School, Universidade Estadual Paulista - UNESP de Botucatu, São Paulo, Brazil. .,Department of Ophthalmology, Botucatu Medical School, Universidade Estadual Paulista - UNESP de Botucatu, São Paulo, Brazil.
| | - Fabiano Yutaka Kakizaki
- Department of Ophthalmology, Botucatu Medical School, Universidade Estadual Paulista - UNESP de Botucatu, São Paulo, Brazil
| | - Laura Almeida Hércules
- Department of Ophthalmology, Botucatu Medical School, Universidade Estadual Paulista - UNESP de Botucatu, São Paulo, Brazil
| | - Carlos Roberto Padovani
- Department of Biostatistic, Biosciences Institute, Universidade Estadual Paulista - UNESP de Botucatu, São Paulo, Brazil
| | - João Manuel Grisi Candeias
- Department of Microbiology and Immunology, Biosciences Institute, Universidade Estadual Paulista - UNESP de Botucatu, São Paulo, Brazil
| | - Silvana Artioli Schellini
- Department of Ophthalmology, Botucatu Medical School, Universidade Estadual Paulista - UNESP de Botucatu, São Paulo, Brazil
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Baiula M, Spampinato S. Phase II drugs under investigation for allergic conjunctivitis. Expert Opin Investig Drugs 2014; 23:1671-86. [DOI: 10.1517/13543784.2014.944640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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