This ester topical corticosteroid targets the entire inflammatory allergic cascade, relieving symptoms rapidly throughout the cascade, and does not typically trigger the adverse events that may be associated with ketone steroids, said Haroon Ilyas, MD, an ophthalmologist in a group practice in Brandon, FL.
"In my personal experience, I have not seen any adverse events from using loteprednol etabonate 0.2% for allergies," Dr. Ilyas said. "It pretty much has become my first choice because I know it's going to take care of the problem. I feel totally comfortable [treating people with] steroids as a first-line treatment."
He also prefers the drug because most of the patients he sees for treatment of ocular allergies have already tried over-the-counter products, including the antihistamine/mast cell stabilizer medications, without success. Left with significant symptoms, they are desperate for relief and are likely to find it with loteprednol etabonate 0.2%, he noted.
Dr. Ilyas' preference is also partly due to a study of loteprednol etabonate 0.2% in which he participated. The retrospective review, which included nearly 400 patients from three private ophthalmologic practices, demonstrated that the drug was safe when used on a long-term basis. No adverse effects from long-term use were reported among a group of 159 patients who had been continuously using the steroid for more than 12 months. This group included 84 patients who had been using loteprednol for at least 2 years and 22 who had been using it at least 3 years. The study appeared in Eye Contact Lens, January 2004.
"We found that loteprednol etabonate 0.2% had an excellent safety profile; there was no significant pressure rise noted in any of the charts of patients who had been using the drug for a long time, and also there was no significant cataract development," Dr. Ilyas said. "People often have concerns about the safety profile of using steroids—including loteprednol—first-line for allergies, but the study I authored showed that patients using it daily for up to 2 to 3 years never developed serious adverse events."
Some of the criticism that has surrounded first-line corticosteroid therapy for allergic con-junctivitis stems from ophthalmic steroids with a specific ketone group found on the number 20 carbon molecule, Dr. Ilyas noted.
Steroids with this chemical structure have been linked to the formation of cataracts as well as potentially harmful adverse effects, such as IOP elevation and the potential to aggravate certain infectious external diseases.
In loteprednol etabonate 0.2%, that ketone group has been replaced by an ester group, a change that significantly improves the safety profile while maintaining efficacy.
Among the many patients he has treated with loteprednol etabonate, one in particular has stayed in Dr. Ilyas' memory because he was a sales representative for a pharmaceutical company with a competing ocular allergy drug—a product that had not been able to reduce his allergy symptoms.
"I [treated him with] loteprednol etabonate, and within a day he was much happier and much more comfortable," he said.
Haroon Ilyas, MD
Dr. Ilyas is a speaker for Bausch + Lomb. However, he was not associated with the company while conducting a retrospective study of loteprednol published in 2004.