Topical cyclosporine A cationic ophthalmic emulsion in paediatric vernal keratoconjunctivitis: pooled analysis of randomised NOVATIVE and VEKTIS trials

• Published in: Eye (London) 2023-08, Vol.37 (11), p.2320-2326
• Main Authors: Leonardi, Andrea, Doan, Serge, Aragona, Pasquale, Amrane, Mourad, Ismail, Dahlia, Montero, Jesús, Németh, János, Bremond-Gignac, Dominique
• Format: Article
• Language: English
• Subjects: 692/308/409; 692/700/1720; Adolescent; Child; Clinical trials; Conjunctivitis, Allergic - chemically induced; Conjunctivitis, Allergic - drug therapy; Cornea; Corneal Injuries; Cyclosporine - therapeutic use; Cyclosporins; Double-Blind Method; Dry Eye Syndromes - drug therapy; Emulsions - therapeutic use; Humans; Immunosuppressive Agents - therapeutic use; Keratoconjunctivitis; Laboratory Medicine; Medicine; Medicine & Public Health; Ophthalmic Solutions; Ophthalmology; Pediatrics; Pharmaceutical Sciences/Technology; Surgery; Surgical Oncology; Treatment Outcome
• ISSN: 0950-222X; 1476-5454
• DOI: 10.1038/s41433-022-02342-6

Background/Objectives Cyclosporine A cationic ophthalmic emulsion (CsA CE) was evaluated in paediatric and adolescent patients with vernal keratoconjunctivitis (VKC) in the NOVATIVE (NCT00328653) and VEKTIS (NCT01751126) trials. The similarity of these studies permitted pooled assessment of the effect of CsA CE on corneal damage as well as safety and tolerability. Subjects/Methods Pooled outcomes were assessed for the first 28 days of treatment. In NOVATIVE, 118 patients were randomised to 4 times daily (QID) CsA CE 0.05%, 0.1%, or vehicle eye drops. In VEKTIS, 169 patients were randomised to CsA CE 0.1% QID or twice daily (BID) or vehicle. For these analyses, treatment groups comprised: (1) pooled CsA CE 0.1% QID arms (high-dose; n  = 96); (2) pooled CsA CE 0.05% QID arm from NOVATIVE and CsA CE 0.1% BID data from VEKTIS (low-dose; n  = 93); and (3) pooled vehicle QID arms (vehicle; n  = 98). Results Changes from baseline to day 28 (mean ± standard deviation) in corneal fluorescein staining (CFS) scores for CsA CE high-dose, low-dose, and vehicle groups were −1.6 ± 1.47 (95% CI: −0.9, −0.1; p  = 0.0124 vs vehicle), −1.7 ± 1.39 (95% CI: −1.1, −0.3; p  = 0.0015 vs vehicle), and −1.0 ± 1.55, respectively. Adverse events (AEs) of any type were reported in 37.5%, 34.4%, and 37.8% of the high-dose, low-dose, and vehicle groups, respectively. Most were mild or moderate in severity. Conclusions CsA CE significantly decreased corneal damage and was safe and well tolerated in patients with VKC. These data support CSA CE as a treatment option for the management of VKC.