Purpose: Cyclosporine ophthalmic emulsion 0.05% (CsA 0.05%) and cyclosporine ophthalmic solution 0.09% (CsA 0.09%) are approved to increase tear production in dry eye disease (DED). We investigated the effect of CsA 0.09% on DED signs and symptoms in patients whose disease was inadequately controlled on CsA 0.05%. In this Phase 4, single-arm, open-label study, adults with DED administered 1 drop of CsA 0.09% in both eyes twice daily for 12 weeks. Patients and Methods: Patients were ≥ 18 years of age with a history and clinical diagnosis of DED for ≥ 3 months, which was not adequately controlled by treatment with CsA 0.05%. The primary efficacy endpoints were mean changes from baseline in total corneal fluorescein staining (CFS) and modified Symptom Assessment iN Dry Eye (mSANDE) scores at Week 12. Secondary efficacy endpoints included mean changes from baseline in total conjunctival staining score, central CFS score, tear osmolarity, Schirmer test score, and frequency of artificial tear use at Week 12, and patient treatment preference at Week 12. Adverse events (AEs) were monitored. Results: The intent-to-treat population comprised 124 patients (mean age, 65.6 years). The mean changes from baseline in total CFS and mSANDE scores were statistically significant at Weeks 4, 8, and 12 ( P < 0.0001 for all). At Week 12, statistically significant improvements from baseline were also noted for total conjunctival staining score, central CFS score, Schirmer test score, and artificial tear use frequency ( P ≤ 0.0029), and 69.4% of patients preferred CsA 0.09%. Most AEs were mild. Conclusion: Treatment with CsA 0.09% elicited statistically significant improvement from baseline in DED signs and symptoms from Weeks 4 to 12 in patients inadequately controlled on CsA 0.05%. Overall, CsA 0.09% was well tolerated. The findings from this study suggest that switching from CsA 0.05% to CsA 0.09% may improve signs and symptoms in patients with DED. Plain Language Summary: In this study, patients with dry eye who were still experiencing symptoms while receiving treatment with cyclosporine ophthalmic emulsion 0.05% were switched to cyclosporine ophthalmic solution 0.09% (CsA 0.09%) for 12 weeks. Both formulations use the anti-inflammatory agent cyclosporine, but CsA 0.09% uses a slightly higher concentration that is dissolved into a solution rather than emulsified in an oil like some other dry eye drops. Patients were assessed using eye stains and questionnaires before switching to CsA 0.09%, which served as the baseline for each patient. Patients were then re-examined and completed another questionnaire regarding their dry eye symptoms every 4 weeks during the 12 weeks they received CsA 0.09%. As early as Week 4, patients on average had improvements in dry eye staining and symptom management (based on their questionnaire scores), which were associated with better control of their dry eye symptoms. At the end of the study, 69% of patients preferred CsA 0.09% over their previous eye drops, and CsA 0.09% was well tolerated by patients and was associated with mostly minor ocular side effects; eye irritation after applying the eye drops was reported most frequently. Taken together, these results suggest that treating dry eye early with CsA 0.09% may be beneficial, and some patients who struggle to adequately control their dry eye symptoms with other dry eye drops may benefit from switching their treatment to CsA 0.09%. Keywords: CEQUA, corneal staining, cyclosporine A, dry eye disease, patient-reported outcome, restasis
Johnston et al. (Sun,) studied this question.