Topical tacrolimus effective for vernal/atopic keratoconjunctivitis

With every 10-year increase in patient age, the risk of the patients needing concomitant administration of steroid eye drops decreased by half, according to investigators.

Japanese investigators reported that extended treatment with topical tacrolimus ophthalmic suspension 0.1% (Talymus, Senju Pharmaceutical Co., Osaka, Japan) to treat vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC) is effective for stabilizing corneas in affected patients. The team was led by Akira Hirota, MD, from the Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, Itabashi-ku, Tokyo.

They explained the severity of these diseases. “Patients with “severe VKC and AKC commonly develop giant papillae, gelatinous limbal infiltration, and corneal epitheliopathy, including punctate corneal keratitis; rarely, they present with corneal shield ulcers in the active and acute exacerbation phases of VKC and AKC. They often have poor responses to medical treatment. Therefore, VKC and AKC are recognized as severe and refractive forms of ACDs,” the researchers emphasized.

The investigators undertook a study1 in which they evaluated the clinical improvement and safety of prolonged tacrolimus treatment for the 2 conditions. The conventional therapy includes antiallergy and corticosteroid eye drops. However, steroids administered over the long term can cause well-known effects such as steroid-induced glaucoma and cataract and infectious keratitis, so another less toxic treatment line is needed.

The study included 1 eye each of 36 patients who had VKC and AKC and were treated with topical tacrolimus ophthalmic suspension (0.1%) for 24 months. The clinical outcomes were determined using papillae–limbus–cornea (PLC) scores and 5-5-5 exacerbation grading scale scores, Dr. Hirota recounted.

Tacrolimus results

After 6 months of treatment, the investigators found significant improvements in the PLC scores compared with baseline and the PLC scores continued to improve at months 18, 21, and 24 months compared with 6 months.

By the 2-year time point, 92% of patients achieved remission.

Another finding was that with every 10-year increase in patient age, the risk of the patients needing concomitant administration of steroid eye drops decreased by half (odds ratio, 0.53; 95% confidence interval, 0.29–0.96).

“Two years of treatment with topical tacrolimus ophthalmic suspension is an effective method for inducing and maintaining the stable stages of VKC and AKC,” the researchers concluded.

Reference
  1. Hirota A, Shoji J,Inada N, et al. Evaluation of clinical efficacy and safety of prolonged treatment of vernal and atopic keratoconjunctivitis using topical tacrolimus. Cornea. 2022;41:23-30; doi: 10.1097/ICO.0000000000002692