Review of Loteprednol Etabonate 0.5%/Tobramycin 0.3% in the Treatment of Blepharokeratoconjunctivitis

Abstract

Use of a combination corticosteroid and antibiotic in a single formulation is common in the treatment of ocular inflammatory conditions for which corticosteroid therapy is indicated and there exists a risk of superficial bacterial infection. Loteprednol etabonate (LE) is a corticosteroid engineered to maintain potent anti-inflammatory activity while minimizing the risk of undesirable class effects of corticosteroids, such as elevated intraocular pressure and cataract. Tobramycin is a broadspectrum aminoglycoside antibiotic that is considered generally safe and well tolerated. An ophthalmic suspension combining LE 0.5% and tobramycin 0.3% (LE/T) is approved in the US and several other countries. Use of a combination therapy increases convenience, which may promote patient adherence. A systematic literature review was conducted to examine the efficacy and safety of LE/T for ocular inflammatory conditions within the scope of its labeled indications. Results of published studies indicate that LE/T is effective in the treatment of blepharokeratoconjunctivitis in adults, with similar efficacy as dexamethasone 0.1%/tobramycin 0.3%, but is associated with a lower risk of clinically significant increases in intraocular pressure as demonstrated in both efficacy and safety studies and studies with healthy volunteers. Furthermore, studies in children with blepharitis or blepharoconjunctivitis indicate LE/T was well tolerated in this population, although efficacy vs vehicle was not demonstrated, potentially due to improvements in all groups overall and/or limited sample size. Separately, tobramycin demonstrated potent in vitro activity against most bacterial species associated with blepharitis. In conclusion, published data demonstrate the utility of LE/T for the treatment of the various clinical manifestations of blepharokeratoconjunctivitis in adults.

Clinical features and comprehensive treatment of persistent corneal epithelial dysfunction after cataract surgery

“…The ocular drug products of tobramycin dexamethasone have utility in treating various clinical manifestations of inflammatory diseases with underlying infectious ocular surface diseases [6]. 0.3% tobramycin/dexamethasone 0.1% significantly reduced ocular inflammation signs (blepharitis, secretions, conjunctivitis) and inflammation score [7].…”

Real-World Use of Loteprednol Etabonate 0.5%/Tobramycin 0.3% Ophthalmic Suspension for the Treatment of Ocular Surface Inflammatory Conditions

“…5,6 Tobramycin is an aminoglycoside with broad-spectrum antibacterial activity, including efficacy against penicillinase-resistant staphylococcal organisms. 3,7 In a recent in vitro study involving 487 unique bacterial isolates (14 genera; 67 species) commonly associated with blepharitis, tobramycin demonstrated low minimum inhibitory concentrations (MICs) against most isolates, including staphylococci (overall, as well as most methicillin-resistant strains). 8 The FDA-approved indication for LE/T is for use in steroid-responsive inflammatory ocular conditions for which a corticosteroid is indicated and where superficial bacterial ocular infection exists.…”