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Reich S, Lopez M, Leff J, Herman J. DEXTENZA versus Topical Steroid or Antihistamine Therapy for Treatment of Allergic Conjunctivitis. Clin Ophthalmol 2024; 18:473-480. [PMID: 38375441 PMCID: PMC10875166 DOI: 10.2147/opth.s440840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/19/2024] [Indexed: 02/21/2024] Open
Abstract
Purpose To compare clinical outcomes and patient preference for the dexamethasone intracanalicular insert (DEX) versus topical loteprednol (LOT) or olopatadine (OLO) for the treatment of allergic conjunctivitis in a real-world model of allergen exposure. Methods This was a prospective comparative trial. Adults with testing-confirmed bilateral allergic conjunctivitis received DEX in the more symptomatic eye and either LOT 2 times daily or OLO once daily for 30 days in the fellow eye. The primary outcome was patient preference for treatment. Clinical outcomes included ocular itching and hyperemia, lid swelling, and watering/tearing. Safety outcomes included intraocular pressure (IOP). Results Thirty patients participated and completed the study. All received DEX in the eye with worse symptoms and 15 received LOT and the other 15 received OLO in the other eye. Patients preferred DEX (10/15; 66.7%) over LOT (4/15; 26.7%), with one patient having no preference (p = 0.0103). Patients had no preference between DEX (8/15; 53.3%) and OLO (6/15; 40%), with one patient having no preference (p = 0.1044). In the DEX/LOT cohort, ocular itching and hyperemia improved more with DEX than LOT (p ≤ 0.009), while in the DEX/OLO cohort, the DEX eyes showed greater improvement in conjunctival hyperemia (p < 0.0001) but not itching (p = 0.074). No between-group differences were seen in eyelid swelling or tearing/watering in either cohort. Mean change in IOP was similar between the DEX and LOT eyes (p = 0.4921), and mean IOP rose more in the DEX eyes than the OLO eyes (by <1 mmHg; p = 0.0403). Conclusion Overall, this real-world study demonstrated that the dexamethasone intracanalicular insert was as effective as a topical antihistamine/mast cell stabilizer and more effective than topical steroids in relieving the signs and symptoms of allergic conjunctivitis. This insert should be considered as an alternative to topical therapy for the treatment of allergic conjunctivitis.
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Affiliation(s)
- Shani Reich
- Clinical Research Center of Florida, Pompano Beach, FL, USA
| | - Maria Lopez
- New England Eye Center/Tufts Medical Center, Boston, MA, USA
| | - Jacqueline Leff
- Touro Osteopathic School of Medicine, Touro University, New York, NY, USA
| | - Jordan Herman
- Clinical Research Center of Florida, Pompano Beach, FL, USA
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Silverstein SM, Sato MA, Meier EJ, Dai S, Bauskar A, Depperschmidt K, Blender N, Vantipalli S, Goldstein MH, Gurses Ozden R. Effects of Punctal Occlusion on Ocular Itching and Conjunctival Redness Associated with Allergic Conjunctivitis. Curr Eye Res 2023; 48:781-787. [PMID: 37199292 DOI: 10.1080/02713683.2023.2211247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 04/19/2023] [Accepted: 05/02/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE Punctal occlusion using punctal plugs has been successfully used to treat the signs and symptoms of dry eye disease. However, the effects of punctal occlusion on the symptoms of allergic conjunctivitis (AC) have been less well documented. There is some concern among clinicians that punctal occlusion may make signs/symptoms of allergic conjunctivitis worse by trapping allergens on the eye. The objective of this post hoc analysis was to address this question and thus assess the effect of punctal occlusion alone on ocular itching and conjunctival redness associated with AC. METHODS This was a pooled post hoc analysis of three randomized, double-blind, placebo insert-controlled clinical trials in subjects with AC. Enrolled subjects were generally healthy adults with ocular allergies and a positive skin test reaction to perennial and/or seasonal allergens. The study used a modified version of the traditional conjunctival allergen challenge (CAC) model, which included multiple, repeated allergen challenges following placement of the intracanalicular insert. Subjects were rechallenged on Days 6, 7 and 8; Days 13, 14 and 15; and Days 26, 27 and 28. RESULTS The data set included 128 subjects that were administered placebo. Baseline mean (SD) ocular itching and conjunctival redness scores were 3.52 (0.44) and 2.97 (0.39), respectively. On post-insertion Days 7, 14 and 28, mean itching scores were 2.62, 2.26 and 1.91, respectively, representing 26%, 36% and 46% itching reductions, respectively (p < 0.001). On Days 7, 14 and 28, mean conjunctival redness scores were 1.98, 1.90, and 2.08, respectively, representing 33%, 36%, and 30% redness reductions, respectively (p < 0.001). CONCLUSIONS Based on this post hoc pooled analysis, punctal occlusion with a resorbable hydrogel intracanalicular insert did not worsen ocular itching or conjunctival redness in this patient population.
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Affiliation(s)
| | | | | | - Stella Dai
- Ocular Therapeutix, Inc., Bedford, MA, USA
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Fram N, Alsetri H, Shiler O, Paterno PJ, Cabang J. Retrospective Study of a Sustained-Release Intracanalicular Dexamethasone Insert for Treatment of Ocular Inflammation After Cataract and Corneal Surgery. Clin Ophthalmol 2022; 16:4065-4074. [PMID: 36532822 PMCID: PMC9749497 DOI: 10.2147/opth.s386702] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/06/2022] [Indexed: 08/12/2023] Open
Abstract
PURPOSE To evaluate the effectiveness and safety of a sustained-release intracanalicular dexamethasone insert (Dextenza, Ocular Therapeutix, Inc.) as an adjunctive therapy in patients undergoing cataract and corneal surgery. PATIENTS AND METHODS This retrospective case series contains 18 patients undergoing cataract surgery and 6 patients undergoing corneal surgery. All patients received the Dextenza intracanalicular insert. 6/18 of the patients in the cataract surgery arm were on the standard of care post-surgery topical steroid drop regimen, whereas 11/18 of the patients were on a reduced regimen. 1/18 of the patients was on a drop regimen that deviated from the aforementioned regimens. 2/6 of the patients in the corneal surgery arm were on the standard of care post-surgery topical steroid drop regimen, whereas 3/6 of the patients were on a reduced regimen. 1/6 of the patients were on a drop regimen that deviated from the aforementioned regimens. RESULTS The primary outcome measures are intraocular pressure (IOP) levels and anterior chamber inflammation levels across the post-operative recovery period. 1/18 of the patients in the cataract surgery arm and 1/6 of the patients in the corneal surgery arm experienced a clinically significant IOP spike greater than 10 millimeters of mercury (mmHg) above baseline IOP. No patient in either of the study groups had significant inflammation after 1 week post-surgery. 1/18 of the patients in the cataract surgery arm and 1/6 of the patients in the corneal surgery arm experienced a canalicular obstruction. CONCLUSION Dextenza with the lower drop protocol showed non-inferiority in terms of inflammation management and safety. As with any steroid delivery mechanism, monitoring IOP is paramount when using Dextenza. One of the patients with a canalicular obstruction had a history of punctal plug implantation, so care should be taken when choosing to implant Dextenza in such a patient.
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Affiliation(s)
- Nicole Fram
- Research Department, Advanced Vision Care, Los Angeles, CA, USA
- Stein Eye Institute, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Hasan Alsetri
- Research Department, Advanced Vision Care, Los Angeles, CA, USA
| | - Orly Shiler
- Research Department, Advanced Vision Care, Los Angeles, CA, USA
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Dierker DS, Hauswirth SG. Thermal Pulsation with or without Dexamethasone Intracanalicular Insert for Meibomian Gland Dysfunction: A Prospective, Masked Trial. Clin Ophthalmol 2022; 16:1477-1485. [PMID: 35585875 PMCID: PMC9109882 DOI: 10.2147/opth.s359719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/28/2022] [Indexed: 11/23/2022] Open
Abstract
Significance Meibomian gland dysfunction (MGD) is among the most common causes of dry eye disease worldwide. Few studies have compared treatment options, and the basis for an evidentiary approach to MGD management is lacking. We have conducted a non-randomized trial evaluating the additive benefit of a recently developed therapy. Purpose To compare the efficacy of thermal pulsation therapy alone or combined with the dexamethasone intracanalicular insert (Dextenza) on the signs and symptoms of MGD. Methods This was a prospective, patient-masked, sham-controlled, non-randomized trial. All subjects underwent thermal pulsation therapy using the LipiFlow system. The dexamethasone intracanalicular insert was placed in the inferior canaliculus of the more symptomatic eye (DEX group), while sham punctal dilation of the fellow eye was performed to preserve patient masking (SHAM group). Key outcomes were improvement in meibum expressibility at 1, 4, and 12 weeks and patient treatment preference at week 12. Results Nineteen subjects underwent thermal pulsation therapy and received the DEX insert. Meibomian gland expressibility scores improved significantly in both groups at 1, 4, and 12 weeks, with significantly greater improvement in DEX eyes than SHAM eyes at 12 weeks (P=0.027). Improvement from baseline in TBUT was significant at all time points in DEX eyes and only at week 4 in SHAM eyes, with significantly greater improvement in DEX eyes over SHAM eyes at week 12 (P=0.028). Mean best-corrected visual acuity and intraocular pressure remained unchanged from baseline throughout follow-up in both groups, and no adverse events were noted. Combined therapy with DEX was preferred by 61% of subjects. Conclusion This study demonstrated a significant benefit of combining thermal pulsation therapy with the dexamethasone intracanalicular insert on signs of MGD including TBUT and meibomian gland expressibility score. Consequently, a majority of patients preferred combination therapy to thermal pulsation therapy alone.
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Affiliation(s)
- Damon S Dierker
- Eye Surgeons of Indiana, Indianapolis, IN, USA
- Correspondence: Damon S Dierker, Eye Surgeons of Indiana, 9202 N Meridian St, #100, Indianapolis, IN, 46260, USA, Email
| | - Scott G Hauswirth
- Department of Ophthalmology, Sue-Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, USA
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Yang Y, Lockwood A. Topical ocular drug delivery systems: Innovations for an unmet need. Exp Eye Res 2022; 218:109006. [DOI: 10.1016/j.exer.2022.109006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/06/2022] [Accepted: 02/20/2022] [Indexed: 02/07/2023]
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McLaurin EB, Evans D, Repke CS, Sato MA, Gomes PJ, Reilly E, Blender N, Silva FQ, Vantipalli S, Metzinger JL, Gibson A, Goldstein MH. Phase 3 Randomized Study of Efficacy and Safety of a Dexamethasone Intracanalicular Insert in Patients With Allergic Conjunctivitis. Am J Ophthalmol 2021; 229:288-300. [PMID: 33773984 DOI: 10.1016/j.ajo.2021.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the efficacy and safety of a dexamethasone intracanalicular ocular insert for the treatment of allergic conjunctivitis. DESIGN Multicenter, randomized, double-masked, placebo-controlled, Phase 3 clinical trial. METHODS Subjects with allergic conjunctivitis were randomized 1:1 to receive a dexamethasone insert or a placebo insert in both eyes and were evaluated using a modified version of the conjunctival allergen challenge (CAC) model. After inserts were placed in office, a series of 4 closely spaced post-insertion CACs were conducted at weeks 1, 2, and 4 across approximately 30 days. Primary efficacy endpoints, assessed at week-1 CAC-day 8, were reported by subjects of ocular itching at 3, 5, and 7 minutes post CAC and investigator-evaluated conjunctival redness at 7, 15, and 20 minutes post CAC. RESULTS For the primary endpoints, dexamethasone inserts showed statistically significantly lower mean ocular itching scores than placebo at all time points (P <.001), with differences favoring dexamethasone inserts over placebo (0.86, 0.98, and 0.96 units at 3, 5, and 7 minutes, respectively) and statistically significantly lower conjunctival redness scores at 20 minutes (P <.05) but not at 7 or 15 minutes (P ≥.05). Results also showed statistically significantly less itching and conjunctival redness at 31 and 29 of 33 other time points, respectively (P <.05). There were no serious adverse events; 1 subject had elevated intraocular pressure in both eyes. CONCLUSIONS Data presented in this study demonstrate the potential for a single, physician-administered dexamethasone intracanalicular insert to provide relief of ocular itching for up to 4 weeks in subjects with allergic conjunctivitis, while maintaining a favorable safety profile.
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Blizzard C, McLaurin EB, Driscoll A, Silva FQ, Vantipalli S, Metzinger JL, Goldstein MH. Plasma Pharmacokinetic Parameters of Dexamethasone Following Administration of a Dexamethasone Intracanalicular Insert in Healthy Adults. Clin Ophthalmol 2021; 15:2055-2061. [PMID: 34040341 PMCID: PMC8140928 DOI: 10.2147/opth.s307194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/12/2021] [Indexed: 02/04/2023] Open
Abstract
Purpose Intracanalicular dexamethasone insert is a resorbable sustained-release polyethylene glycol-based hydrogel insert delivering a 0.4 mg tapered dose of dexamethasone for up to 30 days to the ocular surface. It is FDA-approved for treating inflammation and pain after ocular surgery. It has also been studied for ocular surface diseases such as allergic conjunctivitis. This study assessed the plasma pharmacokinetic (PK) parameters of dexamethasone following intracanalicular insertion. Patients and Methods Study subjects (N=16) were healthy adults. A dexamethasone insert was unilaterally placed into the canaliculus, and blood samples were obtained for analysis 1 hour prior to insertion and 1, 2, 4, 8, 16, 24 hours and 4, 8, 15, 22 and 29 days after insertion. Safety analyses included slit lamp and dilated fundus examinations, best corrected visual acuity, intraocular pressure (IOP) and adverse events (AEs). Results Plasma results were below the lower limit of quantitation (LLOQ) at all time points in five subjects (31.3%). Among subjects with quantifiable plasma concentrations, Cmax was <1 ng/mL (range, 0.05 to 0.81 ng/mL), AUC0-last ranged from 0.13 to 7.18 h∙ng/mL, and Tmax ranged from 4.0 to 163.0 hours. Mean (SD) IOP increased from 16.3 (1.4) mmHg at baseline to 19.3 (3.2) at Day 22 but returned to baseline after treatment. No changes occurred in dilated fundus, punctum, or visual acuity examinations. Conclusion The dexamethasone 0.4 mg insert results in minimal systemic exposure following intracanalicular administration.
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Bertens CJF, Martino C, van Osch MC, Lataster A, Dias AJAA, van den Biggelaar FJHM, Tuinier R, Nuijts RMMA, Gijs M. Design of the ocular coil, a new device for non-invasive drug delivery. Eur J Pharm Biopharm 2020; 150:120-130. [PMID: 32173602 DOI: 10.1016/j.ejpb.2020.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 12/18/2022]
Abstract
Eye drops and ointments are the most prescribed methods for ocular drug delivery. However, due to low drug bioavailability, rapid drug elimination, and low patient compliance there is a need for improved ophthalmic drug delivery systems. This study provides insights into the design of a new drug delivery device that consists of an ocular coil filled with ketorolac loaded PMMA microspheres. Nine different ocular coils were created, ranging in wire diameter and coiled outer diameter. Based on its microsphere holding capacity and flexibility, one type of ocular coil was selected and used for further experiments. No escape of microspheres was observed after bending the ocular coil at curvature which reflect the in vivo situation in human upon positioning in the lower conjunctival sac. Shape behavior and tissue contact were investigated by computed tomography imaging after inserting the ocular coil in the lower conjunctival fornix of a human cadaver. Thanks to its high flexibility, the ocular coil bends along the circumference of the eye. Because of its location deep in the fornix, it appears unlikely that in vivo, the ocular coil will interfere with eye movements. In vitro drug release experiments demonstrate the potential of the ocular coil as sustained drug delivery device for the eye. We developed PMMA microspheres with a 26.5 ± 0.3 wt% ketorolac encapsulation efficiency. After 28 days, 69.9% ± 5.6% of the loaded ketorolac was released from the ocular coil when tested in an in vitro lacrimal system. In the first three days high released dose (48.7% ± 5.4%) was observed, followed by a more gradually release of ketorolac. Hence, the ocular coil seems a promising carrier for ophthalmic drugs delivery in the early postoperative time period.
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Affiliation(s)
- Christian J F Bertens
- University Eye Clinic Maastricht, Maastricht University Medical Center+, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; Maastricht University, School for Mental Health and Neuroscience, University Eye Clinic Maastricht, Universiteitssingel 50, P.O. Box 616, 6200 MD Maastricht, the Netherlands; Chemelot Institute for Science and Technology (InSciTe), Gaetano Martinolaan 63-65, 6229 GS Maastricht, the Netherlands.
| | - Chiara Martino
- Eindhoven University of Technology (TU/e), Department of Chemical Engineering & Institute for Complex Molecular Systems (icms) and Chemistry, Laboratory of Physical Chemistry, P.O. Box 513, 5600 MB Eindhoven, the Netherlands; Chemelot Institute for Science and Technology (InSciTe), Gaetano Martinolaan 63-65, 6229 GS Maastricht, the Netherlands
| | - Marty C van Osch
- Maastricht University, School for Mental Health and Neuroscience, University Eye Clinic Maastricht, Universiteitssingel 50, P.O. Box 616, 6200 MD Maastricht, the Netherlands; Chemelot Institute for Science and Technology (InSciTe), Gaetano Martinolaan 63-65, 6229 GS Maastricht, the Netherlands
| | - Arno Lataster
- Maastricht University, Department of Anatomy and Embryology, Universiteitssingel 50, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Aylvin J A A Dias
- Chemelot Institute for Science and Technology (InSciTe), Gaetano Martinolaan 63-65, 6229 GS Maastricht, the Netherlands; Eyegle bv., Gerbergaplantsoen 11, 6226 DR Maastricht, the Netherlands
| | - Frank J H M van den Biggelaar
- University Eye Clinic Maastricht, Maastricht University Medical Center+, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; Maastricht University, School for Mental Health and Neuroscience, University Eye Clinic Maastricht, Universiteitssingel 50, P.O. Box 616, 6200 MD Maastricht, the Netherlands; Chemelot Institute for Science and Technology (InSciTe), Gaetano Martinolaan 63-65, 6229 GS Maastricht, the Netherlands
| | - Remco Tuinier
- Eindhoven University of Technology (TU/e), Department of Chemical Engineering & Institute for Complex Molecular Systems (icms) and Chemistry, Laboratory of Physical Chemistry, P.O. Box 513, 5600 MB Eindhoven, the Netherlands
| | - Rudy M M A Nuijts
- University Eye Clinic Maastricht, Maastricht University Medical Center+, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; Maastricht University, School for Mental Health and Neuroscience, University Eye Clinic Maastricht, Universiteitssingel 50, P.O. Box 616, 6200 MD Maastricht, the Netherlands; Chemelot Institute for Science and Technology (InSciTe), Gaetano Martinolaan 63-65, 6229 GS Maastricht, the Netherlands
| | - Marlies Gijs
- University Eye Clinic Maastricht, Maastricht University Medical Center+, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; Maastricht University, School for Mental Health and Neuroscience, University Eye Clinic Maastricht, Universiteitssingel 50, P.O. Box 616, 6200 MD Maastricht, the Netherlands; Chemelot Institute for Science and Technology (InSciTe), Gaetano Martinolaan 63-65, 6229 GS Maastricht, the Netherlands
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Brooks CC, Jabbehdari S, Gupta PK. Dexamethasone 0.4mg Sustained-Release Intracanalicular Insert in the Management of Ocular Inflammation and Pain Following Ophthalmic Surgery: Design, Development and Place in Therapy. Clin Ophthalmol 2020; 14:89-94. [PMID: 32021072 PMCID: PMC6968807 DOI: 10.2147/opth.s238756] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/19/2019] [Indexed: 01/19/2023] Open
Abstract
Inflammation and pain are two prevalent findings after ocular surgery. Corticosteroids are widely administrated as a core treatment to control post-surgical inflammation and pain. Improper patient adherence to post-operative eye drop regimens, limited bioavailability of topical eye drops, and the negative impact of preservatives used in many of these eye drops, has made a strong case for novel therapies in the treatment of post-operative pain and inflammation. This review of the literature will focus on the role of intracanalicular sustained-release dexamethasone (Dextenza, Ocular Therapeutix, Bedford, MA, USA) for the management of ocular inflammation and pain.
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Affiliation(s)
- Cassandra C Brooks
- Department of Ophthalmology, Duke University Eye Center, Durham, NC, USA
| | - Sayena Jabbehdari
- Department of Ophthalmology, Duke University Eye Center, Durham, NC, USA.,Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Preeya K Gupta
- Department of Ophthalmology, Duke University Eye Center, Durham, NC, USA
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Meier EJ, Torkildsen GL, Gomes PJ, Jasek MC. Phase III trials examining the efficacy of cetirizine ophthalmic solution 0.24% compared to vehicle for the treatment of allergic conjunctivitis in the conjunctival allergen challenge model. Clin Ophthalmol 2018; 12:2617-2628. [PMID: 30587908 PMCID: PMC6296187 DOI: 10.2147/opth.s185835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of these Phase III studies was to evaluate the efficacy and safety of cetirizine ophthalmic solution 0.24% compared with vehicle in the treatment of allergen-induced conjunctivitis using the Ora conjunctival allergen challenge (CAC)® model. Methods The single-center (Study 1) and multi-center (Study 2), double-masked, randomized, vehicle-controlled, parallel group, CAC studies were conducted over ~5 weeks and four study visits. The study design only differed in entry criteria: Study 2 required more severe allergic conjunctivitis symptoms. Subjects were screened for an allergen response at Visits 1 and 2 and then randomized at Visit 3. Approximately 100 subjects were randomized in each study. The primary efficacy endpoints were ocular itching and conjunctival redness 15 minutes and 8 hours post-treatment, post-CAC. Results Cetirizine treatment administered 15 minutes or 8 hours prior to CAC resulted in significantly lower ocular itching at all time points post-CAC (P<0.0001) compared to vehicle in both studies. Conjunctival redness measured by the investigator was significantly lower after cetirizine treatment compared to vehicle at 7 minutes post-CAC at both 15 minutes and 8 hours post-treatment in both studies (P<0.05). All secondary endpoints were in favor and confirmatory of cetirizine efficacy with significant improvement in chemosis, eyelid swelling, tearing, ciliary redness, and episcleral redness, as well as nasal symptoms (rhinorrhea, nasal pruritus, ear or palatal pruritus, and nasal congestion) post-CAC. The most robust treatment differences were observed in Study 2 where more severe symptoms were required for study entry (P<0.05). No safety concerns for cetirizine ophthalmic solution 0.24% were identified. Conclusion Cetirizine ophthalmic solution 0.24% was shown to be efficacious in the treatment of ocular and nasal signs and symptoms associated with allergic conjunctivitis and demonstrated a favorable safety profile. Clinical efficacy was demonstrated with a 15-minute onset of action and añ8-hour duration of action.
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11
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Bertens CJ, Gijs M, van den Biggelaar FJ, Nuijts RM. Topical drug delivery devices: A review. Exp Eye Res 2018; 168:149-160. [DOI: 10.1016/j.exer.2018.01.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 12/08/2017] [Accepted: 01/11/2018] [Indexed: 12/22/2022]
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12
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Mann BK, Stirland DL, Lee HK, Wirostko BM. Ocular translational science: A review of development steps and paths. Adv Drug Deliv Rev 2018; 126:195-203. [PMID: 29355668 DOI: 10.1016/j.addr.2018.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 01/16/2018] [Accepted: 01/16/2018] [Indexed: 12/14/2022]
Abstract
Developing successful drug delivery methods is challenging for any tissue, and the eye is no exception. Translating initial concepts into advanced technologies treating diseases in preclinical models and finally into functional and marketable products for humans can be particularly daunting. While referring to specific ophthalmic companies and products, this review considers key exchanges that lead to successful translation. By building on basic science discoveries in the academic setting, applied science can perform proof-of-concept work with simple, benchtop experiments. Eventually, simple models need to be translated to more robust ones where cells, tissues, and entire organisms are incorporated. Successful translation also includes performing due diligence of the intellectual property, understanding the market needs, undertaking clinical development, meeting regulatory requirements, and eventually scale up manufacturing. Different stages of the translation can occur in different environments, including moving from academia to industry, from one company to another, or between veterinary and human applications. The translation process may also rely on contract organizations to move through the complex landscape. While the path to a commercial, marketable product may not look the same each time, it is important to design a development plan with clear goals and milestones to keep on track.
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Affiliation(s)
- Brenda K Mann
- EyeGate Pharmaceuticals Inc., Waltham, MA, United States
| | | | - Hee-Kyoung Lee
- EyeGate Pharmaceuticals Inc., Waltham, MA, United States
| | - Barbara M Wirostko
- EyeGate Pharmaceuticals Inc., Waltham, MA, United States; Moran Eye Center, University of Utah, Salt Lake City, UT, United States.
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13
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Rupenthal ID. Drug-device combination approaches for delivery to the eye. Curr Opin Pharmacol 2017; 36:44-51. [DOI: 10.1016/j.coph.2017.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 08/04/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
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