Eyeworld

EW CORNEA 54 April 2018 treating which patients were getting benefit; they were getting it signifi- cantly and they were getting it right away," Dr. Hovanesian said. 1 Dr. Matossian finds that for those who have failed with cyclo- sporine use, the addition of lifite- grast to the armamentarium gives them new hope. She also has a smaller cohort of patients who are on both lifitegrast and cyclosporine. "These are my more severe kerato- conjunctivitis sicca patients," Dr. Matossian said. However, this group is under 25 patients at this point. Such patients use each of the drugs twice a day, staggering them, she explained. Dr. Holland finds he is more likely to use a steroid as his second drop here. "If there was severe in- flammation, I might start lotepred- nol on the onset with lifitegrast," he said. "To me it makes more sense to add an effective steroid like lotepre- dnol than to add a second drug that works on a similar pathway." As for the lifitegrast, this may be good for more than just the signs and symptoms of dry eye disease. Dr. Holland also uses this off-label in cases of corneal inflammation, in patients with vernal keratoconjunc- tivitis and atopic disease because those have a T-cell ideology that he finds the lifitegrast works well on. "I add it to the regimens of my high risk corneal transplant patients," he said, adding that he also uses this on ocular surface stem cell patients. Dr. Hovanesian thinks that over time other uses for lifitegrast will emerge, such as for those with con- ditions like conjunctival chalasis, superior limbic keratoconjunctivitis, and other sources of ocular surface pain where there is inflammation. However, the key area for this drug will remain dry eye. "I don't think that it has a lot of additional roles beyond dry eye, but dry eye is such a big area of need that it's an important drug on that basis alone," he concluded. EW Reference 1. Donnenfeld ED, et al. Safety of lifitegrast ophthalmic solution 5.0% in patients with dry eye disease: A 1-year, multicenter, ran- domized, placebo-controlled study. Cornea. 2016;35:741–8. Editors' note: Dr. Holland and Dr. Matossian have financial interests with Shire. Dr. Hovanesian has financial interests with Shire and Allergan. Contact information Holland: eholland@holprovision.com Hovanesian: johnhova@gmail.com Matossian: cmatossian@matossianeye.com disease or atrophic meibomian glands and a rapid tear breakup time and no inflammation is not going to respond to an anti-inflammatory. But if you pick your patients correct- ly, I've found lifitegrast to be quite successful," Dr. Holland said. Comparing with cyclosporine In his practice, Dr. Holland finds that more patients do better with lifitegrast than cyclosporine as first line therapy. That's not to say that this is true for everyone, he stressed. "If I have a patient who's doing well with cyclosporine, I don't change the therapy," he said. For the classic patient who he would have put on cyclosporine as his first line of therapy, he now first tries lifitegrast and reserves cyclo- sporine for those patients who don't respond. "I do have a small number of patients who fail lifitegrast who will do OK on cyclosporine. But it's more common and more successful when starting lifitegrast first over cyclosporine," Dr. Holland said. Dr. Hovanesian pointed out that he also has certain patients for whom cyclosporine works when lifitegrast doesn't. "But the benefit that lifitegrast seems to have is that it works faster," he said, adding that about 80% of cyclosporine patients don't know whether or not the drug is helping them. However, with lifitegrast there is a clearer link in patients' minds, he finds. "They start to see a benefit in just a couple of weeks, as opposed to 3 months for cyclosporine," he said. In his experience, lifitegrast begins to work in the first couple of weeks. "We were part of the masked safety trial with the drug, and it was evident even at that early stage of Zeroing continued from page 53 A new topical cyclosporine Joseph Tauber, MD, describes a new higher concentration high bioavailability topical cyclosporine preparation in clinical trials. EWrePlay.org Xiidra: A novel treatment for dry eye Eric Donnenfeld, MD, discusses the use of Xiidra, a novel dry eye medication. EWrePlay.org

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