Vernal keratoconjunctivitisResult of a novel therapy with 0.1% topical ophthalmic FK-506 ointment

Vichyanond, Pakit; Tantimongkolsuk, Chiraphan; Dumrongkigchaiporn, P.; Jirapongsananuruk, Orathai; Visitsunthorn, Nualanong; Kosrirukvongs, Panida

doi:10.1016/j.jaci.2003.10.065

Cited by 81 publications

(73 citation statements)

References 9 publications

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“…25,26 Furthermore, to treat allergic disease, some studies have used either a commercially available 0.03-0.1% 'skin' ointment applied to eyelids 17,18,20,27 or fornix, 21 or they have used their own-made 0.02-0.1% ointment for the eye. 22,23 Because it is more convenient to use an eye drop rather than an ointment, Sengoku et al 28 used 0.01-1% eye drop in an animal study of ocular allergy and Ohashi et al 24 used an 0.1% ophthalmic suspension for a clinical study. The latter was formulated to be an isotonic aqueous suspension using polyvinyl alcohol as dispersive agent.…”

Section: Discussionmentioning

confidence: 99%

“…In some previous studies, topical tacrolimus has been used just for 4 weeks in VKC with no follow-up after cessation of the treatment. 22,24 In the study by Miyazaki et al, 23 treatment with topical tacrolimus was continued for 7 months. Although improvement of clinical findings has been reported after topical tacrolimus, there is paucity of data regarding the optimal duration of the treatment.…”

Section: Discussionmentioning

confidence: 99%

“…22,23 In a recent study, 0.1% ophthalmic suspension of tacrolimus has been used for treatment of AKC and VKC with only 4 weeks of follow-up. 24 However, the long-term effects of the treatment remain unknown.…”

Section: Introductionmentioning

confidence: 99%

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Topical 0.005% tacrolimus eye drop for refractory vernal keratoconjunctivitis

Kheirkhah

Zavareh

Farzbod

et al. 2011

Eye

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Purpose To evaluate the efficacy and safety of topical 0.005% tacrolimus eye drop for treatment of refractory vernal keratoconjunctivitis (VKC). Methods This prospective study included 20 eyes of 10 patients with refractory VKC, who had active symptomatic disease despite conventional medications including topical steroids. After discontinuing all other medications, patients were treated with topical 0.005% tacrolimus eye drop four times a day. Changes in subjective symptoms and objective signs after treatment were evaluated, and development of possible complications was assessed. Results Mean age of patients was 21.3±7.4 years and mean duration of VKC was 12.1±5.8 years. After starting tacrolimus eye drop, patients were followed for a mean duration of 10.7 ± 3.7 months (range, 6-15 months). All symptoms including itching, redness, photosensitivity, foreign body sensation, and mucus discharge improved after the treatment; itching was the first symptom to show dramatic relief. In addition, there was improvement in objective signs including conjunctival hyperaemia, conjunctival papillary hypertrophy, giant papillae, limbal hypertrophy, corneal punctate epithelial erosions, and corneal pannus; conjunctival hyperaemia was the first sign to show improvement. No patient required addition of other medications including steroids for further relief. Any attempt to discontinue tacrolimus eye drop was associated with recurrence of patients' symptoms and signs, necessitating continued use of the medication during the entire follow-up time. No ocular complication related to tacrolimus was noted. Conclusion Topical 0.005% tacrolimus eye drop seemed to be a safe and effective treatment for steroid-resistant refractory VKC; however, long-term use was needed to control the disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Topical 0.005% tacrolimus eye drop for refractory vernal keratoconjunctivitis

Kheirkhah

Zavareh

Farzbod

et al. 2011

Eye

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“…Based on the effi cacy of tacrolimus ointment in treating atopic dermatitis, it has been successfully used at concentrations of 0.02%-0.1% in ointment for various immune-mediated ocular surface disorders. [15][16][17][18][19][20] However, the effi cacy of tacrolimus eye drops has not been prospectively evaluated in a randomized controlled trial. We conducted a placebocontrolled trial to evaluate the effi cacy of tacrolimus ophthalmic suspension 0.1% in patients with severe allergic conjunctivitis refractory to conventional treatment.…”

Section: Discussionmentioning

confidence: 99%

A Randomized, Placebo-Controlled Clinical Trial of Tacrolimus Ophthalmic Suspension 0.1% in Severe Allergic Conjunctivitis

Ohashi

Ebihara

Fujishima

et al. 2010

Journal of Ocular Pharmacology and Therapeutics

152

106

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Aims: To examine the effi cacy of tacrolimus ophthalmic suspension 0.1% in treating severe allergic conjunctivitis. Methods: This was a multicenter, randomized, double-masked, placebo-controlled clinical trial. Fifty-six patients with severe allergic conjunctivitis in whom topical antiallergic agents and corticosteroids had been ineffective were randomized to tacrolimus or placebo treatment. Patients were treated either with tacrolimus or placebo twice-daily for 4 weeks. Severity of objective signs in palpebral and bulbar conjunctiva, limbus, and corneal involvement was assessed using 4 grades. Seven subjective symptoms were evaluated by visual analog scale (VAS) assessment. The primary effi cacy endpoint was change in the total score of objective signs at the end of treatment. The secondary effi cacy endpoints included change in the score for each objective sign and change in the VAS for each subjective symptom. Safety was assessed based on the severity and the incidence of adverse events. Results: Mean change from baseline in total score for objective signs was signifi cantly greater in the tacrolimus (−5.6 ± 5.1) than in the placebo group (−0.1 ± 4.5; P < 0.001). Tacrolimus signifi cantly improved giant papillae ( P = 0.001) and corneal involvement ( P = 0.005). Five subjective symptoms (itching, discharge, hyperemia, lacrimation, and foreign body sensation) were signifi cantly better in the tacrolimus than in the placebo group. The most frequent treatment-related adverse event in the tacrolimus group was mild ocular irritation upon topical instillation, which was well-tolerated. Conclusion: Tacrolimus ophthalmic suspension 0.1% is effective in treating severe allergic conjunctivitis.

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“…Treatments for allergic conjunctivitis have been continuously evolving since the early nineties, and several levels of therapeutic intervention have been described. Primary intervention is related to avoid offending antigens without pharmacological measures; secondary intervention is directed to control local effector functions of mast cells/eosinophils/basophils with H1-and H2-receptor antagonists, Disodium cromoglycate, Nedocromil sodium, anti-inflammatory drugs (non-steroids or steroids) (Bielory et al, 2005) and in severe cases, tertiary intervention with immune suppressor therapy, such as ciclosporin or tacrolimus has been used (Daniell et al, 2006;Vichyanond et al, 2004).…”

Section: Conventional Therapeutic Intervention and New Immunological mentioning

confidence: 99%