<p>An Updated Systematic Review With Meta-Analysis Of Randomized Trials On Topical Cyclosporin A For Dry-Eye Disease</p>

Abstract

Background/Aims: To evaluate the effects of topical cyclosporin A (CsA) and artificial tears (ATs) for treating patients with dry-eye disease (DED). Methods: On January 25, 2019, five electronic databases and reference lists were searched for randomized clinical trials (RCTs) comparing CsA with ATs among patients with DED. The search strategy had no restriction on language or time. Two authors extracted surgery, mean age, anesthesia for Schirmer's test, tear-breakup time, Schirmer's test score, fluorescein-staining score, ocular surface-disease index, and adverse events. Mean differences (MDs) were calculated for continuous outcomes and Peto ORs for dichotomous data with zero cells. Results were analyzed with 95% CIs in a random-effect model. Results: Eleven RCTs recruiting 1,085 cases with DED were included. Pooled results showed that CsA had better tear-breakup time (MD 0.94, 95% CI 0.08-1.80), fluoresceinstaining score (standardized MD −0.72, 95% CI −1.28 to −0.16), and ocular surface-disease index (MD −4.75, 95% CI −6.31 to −3.18) when compared to ATs. Although CsA had more adverse events than ATs (Peto OR 7.70, 95% CI 3.17-18.68), no serious adverse events were reported. Conclusion: Overall, CsA is an effective option for treating patients with DED, yet our evidence indicated decreasing effects when CsA was combined with ATs. CsA may be worth suggesting to relatively older patients with DED. We anticipate further RCTs to explore the effects of treatment duration, optimal dosage, and efficacy of CsA in different DED etiology.

The Efficacy and Safety of Varenicline Nasal Spray for the Management of Dry Eye Signs: A Systematic Review and Meta-analysis

“…Later, the United States Food and Drug Authority approved cyclosporine as a treatment option for moderate to severe DED. A systematic review and meta-analysis in 2020 concluded that cyclosporine had substantial e cacy for treating DED that was, nevertheless, attenuated upon combining it with arti cial tears (17). A Cochrane review had low-certainty evidence on whether cyclosporine and arti cial tears combination had a superior effect on reducing the symptoms and signs of DED in comparison to arti cial tears monotherapy.…”

OC-01 (Varenicline Solution) Nasal Spray Demonstrates Consistency of Effect Regardless of Age, Race, Ethnicity, and Artificial Tear Use

“…Interestingly, although the prescribing information for the most common topical prescription medications, cyclosporine A and lifitegrast, suggests these drugs are effective in both younger and older patients, 20 , 21 a recently published meta-analysis suggests that cyclosporine A may be more effective in a relatively older population. 22 Given the multifactorial and heterogenous nature of dry eye disease, there is a need to better characterize whether a treatment response to therapy is assessed across specific groups of patients and determine if the data demonstrate consistency of treatment effect outcomes across diverse patient subgroups.…”

“…Other approved prescription pharmaceutical treatment options for dry eye disease that act via reducing associated inflammation have shown mixed results regarding concomitant artificial tear use. A recent systematic review and meta-analysis found that cyclosporine A had reduced treatment effects when combined with artificial tears, 22 which suggests that there may be a potential washout effect. In addition, the prescribing information for cyclosporine A recommends use with artificial tears as long as there is at least 15 minutes between treatments, 20 which may complicate patient treatment administration.…”

Recommendations for Off-Label Drug Use in Ophthalmology in China: A Clinical Practice Guideline

“…Studies retrieved did not differentiate between various levels of dry eye severity. The latest systematic review ( Tuan et al, 2020 ) ( n = 1085, 11 RCTs, moderate certainty evidence, Supplementary Table S25 ) showed that 0.05% cyclosporine eye drops alone or in combination with artificial tears could improve dry eye symptoms better than artificial tears alone. Still, the incidence of treatment-related adverse events is high, such as burning pain and stabbing pain.…”