Management of inflammation in dry eye disease:

What is preventing you from prescribing Ikervis for your patients with DED?

• I feel that CsA should be a last resort and I usually refer to a specialist to start it

  

  “A decision to use CsA eye drops for the management of inflammation in DED should be based on consideration of several clinical risk factors. Important factors that should be considered include:¹

  • severity of corneal and conjunctival staining
  • presence or absence of immune-related systemic disease
  • rapid response to corticosteroid therapy
  • inadequate control on standard of care treatment”

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  “For patients presenting with clinical risk factors for developing severe DED, the early initiation of CsA eye drops should be considered.”¹

• I’m not sure about the bridging regime between CsA and corticosteroids

  

  “Bridging CsA with corticosteroids can be used to offset the relatively fast onset of the anti-inflammatory effect of a topical steroid and the relatively slow onset of the anti-inflammatory effect of CsA. If used:¹

  • CsA treatment can be initiated at the same time as the corticosteroid
 treatment or up to a week afterwards
  • the dose of the corticosteroid may be tapered off in accordance with changes
 in the signs and symptoms of inflammation”

  Graph representing the bridging approach

  

  Reproduced with permission from Messmer E M et al, 20221

• How do I assess the efficacy of CsA in my patients?

  

  “Treatment efficacy can be assessed from as early as 1-3 months after the initiation of treatment. Symptom improvement including reduction in blurred vision, reduced ocular surface staining and improved tear film breakup time are the main indicators of CsA efficacy.”¹

• I’m not sure when I should stop CsA

  

  “CsA treatment may be continued indefinitely if it is well tolerated and effective, although tapering and stopping should be considered if a sufficient and sustained improvement is achieved; treatment should be discontinued in the event of poor tolerance, a lack of efficacy or patient choice.”¹

• My patients struggle to adhere to treatment

  

  “Patient education is critical for optimising patient adherence to CsA. Suggested topics for discussion with patients prior to/during treatment include:¹

  • delay between start of therapy and a noticeable response
  • possible adverse events including a burning sensation on CsA instillation, 
 which should lessen over time as the ocular surface improves
  • corticosteroids may need to be used at the beginning of treatment and during
 possible flare-ups, and to continue use of artificial tears
  • CsA has no (or almost no) systemic effect”

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  “A small proportion of patients may need to stop CsA treatment due to an [adverse event]. Additional steps can be taken to alleviate discomfort from CsA use (eg using artificial tears and topical corticosteroids). It is also important to inform the patient of the potential for experiencing discomfort with this treatment, and to recommend keeping the drug refrigerated so that the drops are cool upon instillation.”¹

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  The most common adverse reactions are eye pain (19.0%), eye irritation (17.5%), ocular hyperaemia (5.5%), lacrimation increase (4.9%) and eyelid erythema (1.7%) which are usually transitory and occurred during instillation.²
  Please consult the Summary of Product Characteristics for a full list of adverse events.