Eyeworld

DECEMBER 2020 | EYEWORLD | 107 C "Side effects that were deal breakers for pa- tients were much less common than in the FDA study, but they were more severe when they occurred," he said. "People who had pain really had pain, and people [who] had blurred vision really had blurred vision. Now, interestingly, dysgeusia was more severe, but fewer people actually got it. We all know the Restasis story: Restasis burns. It hurts until it doesn't hurt." If you can get patients to stay on their med- ications, Dr. White said they more often than not improve. "It's not surprising that people start it and stop it," he said. "Those who do get better need encouragement to stay on the medication to avoid a relapse or recurrence of symptoms." Looking at the study findings as a practi- tioner, Dr. White said he now wants to go back and do the study again, looking at commercially insured patients only. "I want to look at changes and adherence as defined by a refill being filled at either the 6- or 9-month period because now we have a very mature commercial market," he said. Contact White: darrellwhite@mac.com away. Looking at that, Dr. White said, you would think patients would need to refill at 30 days for a 1-month supply or 90-days for a 3-month supply. "In reality, the vast majority of patients, at their doctor's encouragement, will use a Restasis dropperette a minimum of three times. That means a 3-month supply is going to last for 9 months. With Xiidra, there are precisely five drops in the dropperette, which means if you get good at it, you can get two doses out of it, so a single 3-month prescription could last for 6 months." In light of this perspective, Dr. White said it's helpful to look at the 9-month data from the study. At this point, Dr. White said about 70% of patients were off their medications. Why aren't patients staying on these drugs long term? The reasons are likely varied and multifold. "We live in a Tylenol society. You have a headache, you take a Tylenol, and 30 minutes later you feel better," Dr. White said, adding later, "Dry eye doesn't work like that." Dry eye takes awhile to become symptom- atic for patients, he explained. At that point, the underlying pathophysiology and inflammation/ negative feedback cycle that's been established cannot be undone quickly. "You're giving someone a medication that is going to take awhile to work. … As the prescrib- ing doctor, you have to believe that it's going to work because you are now a cheerleader. You have to do whatever it takes to convince your patient that they should go on the medication, then convince them that it's necessary to stay on it. Making it a greater challenge is that both of the medications in this particular study can be uncomfortable. They both have side effects, and the side effects are unpredictable," Dr. White said. Dr. White said for lifitegrast, side effects "out in the wild" were different than those in the clinical trials. Reference 1. White DE, et al. Real-world treatment patterns of cyclospo- rine ophthalmic emulsion and lifitegrast ophthalmic solution among patients with dry eye. Clin Ophthalmol. 2019;13:2285– 2292. Relevant disclosures White: Allergan, Novartis, Sun Ophthalmics "We live in a Tylenol society. You have a headache, you take a Tylenol, and 30 minutes later you feel better. Dry eye doesn't work like that." —Darrell White, MD

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