Intracanalicular drug depot may fill unmet need for better topical therapy

Take-home message: A sustained-release dexamethasone intracanalicular depot may be able to treat post-cataract surgery inflammation without causing spikes in IOP. The product’s one-time administration may also improve compliance and convenience.

 

 

By John Berdahl, MD, Special to Ophthalmology Times

Sioux Falls, SD-With all the improvements in cataract surgery over the years, the need for better topical therapies post-procedure continues to be unmet.

Post-surgical anti-inflammatories-such as corticosteroids-are a vital element in the process to promote healing and combat pain and inflammation, which can lead to other issues. However, while necessary to obtain positive outcomes, the inconsistency of patient delivered steroids drops could lead to variable response.

Additionally, the post-surgical drop regimen can be inconvenient, costly, and confusing for patients. Many struggle with adherence, especially those previously inexperienced with drop administration.¹

These issues are exacerbated when long-term administration is necessary. According to IMS Health Data, more than 20 million anti-inflammatory eye drop prescriptions were filled in 2015-corticosteroids comprising about 8.9 million of those.² Studies of patients with chronic diseases have found that only 10% of patients showed a consistently proficient pattern of compliance through 1 year³ and only 15% adhered consistently over 4 years.⁴

Though these studies highlight long-term medications, they serve to show the difficulty patients often have with self-administering ocular medications. Treatment options that reduce the number of drops a patient must administer and put control over adherence in the physician’s hands are of great benefit to the patient. With the physician at the helm, medication delivery is assured-helping improve positive outcomes.

New mechanism of action

The question then becomes: What is the best way to deliver necessary steroid medications? Dropless cataract surgery (Imprimis Pharmaceuticals) may be a viable approach.

However, some physicians believe a postoperative nonsteroid anti-inflammatory drug is still necessary to combat inflammation. Additionally, not all patients are good candidates for the dropless approach due to preference or pathology. Those who will need a steroid post surgery will continue to struggle through the confusing drop regimen and often expensive topical therapy treatments.

With the advent of an ocular pain treatment (Dextenza, Ocular Therapeutix), ophthalmologists worldwide may have a new alternative to traditional steroid therapy with drops. The preservative-free, hydrogel-based, intracanalicular depot delivers a sustained-release dose of dexamethasone over a period of 4 weeks.

The intracanalicular depot form-fits within the canaliculus. The depot becomes soft following insertion through contact with moisture, thereby contracting in length and expanding in diameter once in place. As it is administered by the physician in a one-time procedure, adherence is assured and convenience for the patient is greatly improved.

Retention rates in the phase II trials were strong, with the intracanalicular drug depot group demonstrating 100% retention through day 14, and 97% through day 30.⁵ Current phase III trials are demonstrating similarly strong rates.

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