A prospective study to compare the efficacy of tacrolimus vs cyclosporine in vernal keratoconjunctivitis in children in India
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20192193Keywords:
Tacrolimus, Cyclosporine, Vernal keratoconjunctivitis, ImmunomodulatoryAbstract
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.
Metrics
References
Bielory L. Allergic and immunologic disorder of the eye. Part II: Ocular allergy. J Allergy Clin Immunol. 2000;106:1019-32.
Leonardi A. Vernal keratoconjunctivitis: pathogenesis and treatment. Prog Retin Eye Res. 2002;21:319-39.
Bonini S. Atopic keratoconjunctivitis. Allergy. 2004;59:(78):71-3.
Cook EB. Tear cytokines in acute and chronic ocular allergic inflammation. Curr Opin Allergy Clin Immunol. 2004;4:441-5.
Ohashi Y, Ebihara N, Fujishima H. A randomized, placebo-controlled clinical trial of tacrolimus ophthalmic suspension 0.1% in severe allergic conjunctivitis. J Ocul Pharmacol Ther. 2010;26:165-73.
Tabbara KF. Ocular complications of vernal keratoconjuctivitis. Can J Ophthalmol. 1999;34:88-92.
Ang M, Ti SE, Loh R. Steroid-induced ocular hypertension in Asian children with severe vernal keratoconjunctivitis. Clin Ophthalmol. 2012;6:1253-8.
Ohji M, Kinoshita S, Ohmi E. Marked intraocular pressure response to instillation of corticosteroids in children. Am J Ophthalmol. 1991;112:450-4.
Tomida I, Schlote T, Bräuning J, Heide PE, Zierhut M. Cyclosporin A 2% eyedrops in therapy of atopic and vernal keratoconjunctivitis. Ophthalmol. 2002;99(10):761-7.
Akpek EK, Dart JK. A randomized trial of topical cyclosporin 0.05% in topical steroid-resistant atopic keratoconjunctivitis. Ophthalmol. 2004;111(3):476-82.
Takamura E, Uchio E, Ebihara N, Ohno S, Ohahsi Y. Japanese guidelines for allergic conjunctival diseases. Allergol Int. 2011;60(2):191-203.
Bonini S. Vernal keratoconjunctivitis revisited: a case series of 195 patients with long-term follow up. Ophthalmol. 2000;107(6):1157-63.
Vichyanond P. A double-masked comparison of 0.1% tacrolimus ointment and 2% cyclosporine eye drops in the treatment of vernal keratoconjunctivitis in children. Asian Pac J Allergy Immunol. 2012;30:177-84.
Müller GG, José NK, Castro RS. Topical tacrolimus 0.03% as sole therapy in vernal keratoconjunctivitis. Eye Contact Lens. 2014;40(2):79-83.
Pucci N, Caputo R. Long-term safety and efficacy of topical cyclosporine in 156 children with vernal keratoconjunctivitis. Int J Immunopathol Pharmacol. 2010;23(3):865-71.
Pucci N, Caputo R. Tacrolimus vs cyclosporine eyedrops in severe cyclosporine-resistant vernal keratoconjunctivitis: a randomized, comparative, double-blind, crossover study. Pediatr Allergy Immunol. 2015;26(3):256-61.
Gupta V, Sahu PK. Topical cyclosporin A in the management of vernal keratoconjunctivitis. Eye (London, England). 2001 Feb;15(Pt 1):39-41.
Ebihara N, Ohashi Y, Fujishima H, Fukushima A, Nakagawa Y. Blood level of tacrolimus in patients with severe allergic conjunctivitis treated by 0.1% tacrolimus ophthalmic suspension. Allergol Int. 2012;61:275-82.