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Real-World Treatment Patterns of Cyclosporine Ophthalmic Emulsion and Lifitegrast Ophthalmic Solution for Dry Eye
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Clinical Ophthalmology (Auckland, N.Z.)
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Real-World Treatment Patterns of Cyclosporine Ophthalmic Emulsion and Lifitegrast Ophthalmic Solution Among Patients With Dry Eye
Clin Ophthalmol 2019 Jan 01;13(xx)2285-2292, DE White, Y Zhao, A Ogundele, N Fulcher, A Acs, L Moore-Schiltz, PM KarpeckiFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Since this paper judged noncompliance retrospectively by whether or not the patient refilled the prescription, it is possible it was not refilled because it solved the problem. However, given that DED is a chronic problem, and cyclosporine takes longer than a month for its therapeutic effect to activate, it is unlikely that the patients discontinued the drop because their DED cleared up. Or the inverse may have happened—they may have discontinued due to uncomfortable side-effects of the drop, or due to the time or cost in refilling the prescription. In any event, it shows that nonadherence is an issue that needs to be addressed.
Dry eye disease (DED) is a pervasive condition which can drastically impact quality of life. One would think that mitigating the cause of dry eye and ultimately its symptoms would be welcomed by the vast majority of patients experiencing this discomfort. There are two such medications which are proven to do just that and are FDA-approved: cyclosporine ophthalmic emulsion 0.05% (CYC), and lifitegrast 5% ophthalmic solution (LIF). Notably, for these treatments, it appears that continued use is often not the case and, in fact, the conclusion in the study that “over 60% of DED patients discontinued treatment within 12 months of initiation; the median time to discontinuation was three months for CYC and one month for LIF” will not come as a surprise to most clinicians, especially those with a predominantly geriatric population (the majority of patients in this study were between 55 and 64 years ). This study underscores what I have experienced in my practice with respect to these dry eye disease medications. Specifically, patients stop for one or all of three reasons suggested in this study: financial considerations, adverse effects, or lag time between treatment initiation and symptomatic relief. I have found that there are no magical answers to these barriers, especially for the issue of cost. So, until these reasons for stopping can be addressed, the only thing a practitioner can do is predict these potential barriers for patients before treatment begins, be there to support these patients in any way possible, and offer other, possibly less beneficial, alternatives.