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Abstract #19316 Published in IGR 9-3
Clinical experience with topical corticosteroids and other therapies
Bielory LAllergy and Clinical Immunology International 2007; 19: 19-26
The safety and efficacy of antihistamine/mast-cell stabilizers, nonsteroidal antiinflammatory drug (NSAID), and topical corticosteroids was demonstrated in clinical studies of patients with different types of ocular allergy and inflammatory conditions. A comparative clinical study of the efficacy and tolerability of olopatadine hydrochloride 0.1% ophthalmic solution and loteprednol etahonate 0.2% ophthalmic suspension in a conjunctival allergen challenge model demonstrated that olopatadine reduced the acute signs and symptoms of intermittent (seasonal) allergic conjunctivitis (IAC) more than loteprednol in the early phase of the allergic reaction. Another comparative clinical study between ketorolac tromethamine 0.5%, a topical nonsteroidal antiinflammatory agent, and loteprednol etabonate 0.5% investigated the effect of these agents in controlling inflammation after cataract surgery. It was concluded that ketorolac was as effective as loteprednol in this study. In a 4-week study of giant papillary conjunctivitis (GPC), loteprednol etabonate 0.5% significantly improved clinical signs and symptoms of GPC compared to placebo. Incidences of elevated intraocular pressure (IOP) and other adverse events were low in both treatment groups. In two 6-week placebo-controlled IAC studies, loteprednol etabonate 0.2% showed higher efficacy than placebo with complete resolution of symptoms such as bulbar conjunctival injection and itching. The safety profile of loteprednol etabonate was similar to that of placebo. The incidence of elevated IOP, defined as pressure increases of > 10 mmHg, was low for both loteprednol etabonate and placebo. Two studies on patients with acute anterior uveitis were performed, in which the efficacy and safety of loteprednol etabonate 0.5% was compared to prednisolone 1.0%. Loteprednol etabonate was slightly less effective than prednisolone in each study. However, combined data from these studies demonstrated a lower incidence of elevated IOP in the loteprednol etabonate group than the prednisolone group. Retrospective analysis of long-term data of loteprednol etabonate in the treatment of IAC and persistent (perennial) allergic conjunctivitis (PAC) demonstrated a very low incidence of cataract formation in patients treated with loteprednol etabonate 0.2% for at least 12 months. These data suggest loteprednol etabonate represents a safer treatment option to ketone corticosteroids, in particular when used for "short bursts" of up to 2-week periods. A placebo-controlled, randomized, parallel group, single center study comparing the therapeutic effects of 0.1% olopatadine hydrochloride and 0.5% ketorolac tromethamine demonstrated that both agents were effective in alleviating the clinical signs and symptoms of IAC even though they have different pharmacological mechanisms. However, olopatadine relieved ocular itching significantly better than ketorolac. The safety and efficacy of 0.5% ketorolac tromethamine and levocabastine in the treatment of IAC were compared in a multi-center, double-masked, randomized, parallel group clinical trial. It was found that both treatments were effective and well tolerated in this patient population.
Dr. L. Bielory, 400 Mountain Avenue, Springfield, NJ 07081, USA. bielory@mac.com
Classification:
9.4.1 Steroid-induced glaucoma (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)
