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The efficacy of topical 0.05 % cyclosporine A in patients with dry eye disease associated with Sjögren’s syndrome

Abstract

Sjögren’s syndrome (SS) is an autoimmune epithelitis which usually presents with mouth and eye dryness. Although the place of systemic drugs in keratoconjunctivitis sicca treatment has been discussed, the efficacy of some topical drugs has also been demonstrated; however, there are contradictory results related to topical cyclosporine A. We aimed to investigate the efficacy of 0.05 % topical cyclosporine A in patients with keratoconjunctivitis sicca due to primary and secondary SS. This prospective study included 26 patients with a diagnosis of primary and secondary SS who visited our rheumatology outpatient clinic. Keratoconjunctivitis sicca was diagnosed in all patients after they were examined at the outpatient clinic. Patients were given topical 0.05 % cyclosporine A emulsions for both eyes. We used another 20 patients with SS who were treated with saline solution as a control group. Subjective symptoms reported after 1-week and 1-month follow-up were complaints of burning and pricking sensation, light sensitivity and pain. Objective signs included redness, Schirmer test and tear break-up time. A total of 26 patients (19 female) were enrolled in the study with a mean age of 47.5 years and mean disease duration of 5.2 years. In the first physical examination of patients, 23 patients had burning and pricking sensation, 24 had pain, 23 had light sensitivity, and 24 had red eyes. All subjective symptoms (burning and pricking sensation, light sensitivity and pain) were statistically significantly improved after 1-week and 1-month follow-up examinations (p = 0.0001). All objective signs (Schirmer test, tear break-up time, and redness) were statistically significantly improved after 1-week and 1-month follow-up examinations (p = 0.0001). Compared with the control group, there was significant improvement in all parameters. It is concluded that topical 0.05 % cyclosporine A is an effective treatment option for keratoconjunctivitis sicca due to SS after a 1-month follow-up period.

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References

  1. Haralampos M, Moutsoupolos MD (1980) Sjögren’s syndrome (sicca syndrome): current issues. Ann Intern Med 92:212–226

    Article  Google Scholar 

  2. Kanski JJ (1999) Keratoconjunctivitis Sicca. Disorders of the conjunctiva. Butterwotrh-Heinemann International Edition (4th), Clinical Ophthalmology 78–79

  3. Pflugfelder SC, Solomon A, Stern ME (2000) The diagnosis and management of dry eye. A twenty-five-year review. Cornea 19:644–649

    CAS  PubMed  Article  Google Scholar 

  4. Braida M, Knop J (1986) Effect of cyclosporine A on the T-effector and T-supressor cell response in contact sensitivity. Immunology 59:503–507

    CAS  PubMed Central  PubMed  Google Scholar 

  5. Taylor AL, Watson CJE, Bradley JA (2005) Immunosupressive agents in solid organ transplantation. Mechanism of action and therapeutic efficacy. Crit Rev Oncol Hematol 7:23–46

    Article  Google Scholar 

  6. Tsubota K, Fujita H, Tadano K et al (2001) Improvement of lacrmal function by topical application of CyA in murine models of Sjogren’s syndrome. Invest Ophthalmol Vis Sci 42:101–110

    CAS  PubMed  Google Scholar 

  7. Stevenson D, Tauber J, Reis BL (2000) A Phase 2 study group efficacy and safety of cyclosporin A ophthalmic emulsion in the treatment of moderate to severe dry eye disease. Ophthalmology 107:967–974

    CAS  PubMed  Article  Google Scholar 

  8. Kunert KS, Tisdale AS, Gipson IK (2002) Goblet cell numbers and epithelial proliferation in the conjunctiva of patients with dry eye syndrome treated with cyclosporine. Arch Ophthalmol 120:330–337

    CAS  PubMed  Article  Google Scholar 

  9. Sall K, Stevenson OD, Mundorf TK, Reis BL (2000) Two multicenter, randomized studies of the efficacy and safety of cyclosporine ophtalmic emulsion in moderate to severe dry eye disease. Ophthalmology 107:631–639

    CAS  PubMed  Article  Google Scholar 

  10. Vitali C, Bombardieri S, Jonsson R et al (2002) European study group on classification criteria for Sjogren’s syndrome. Classification criteria for Sjogren’s syndrome: a revised version of the European criteria proposed by the American-European concensus group. Ann Rheum Dis 61:554–558

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  11. Shapiro A, Merin S (1979) Schirmer test and break-up time of tear film in normal subjects. Am J Ophtalmol 88:752–757

    CAS  Google Scholar 

  12. Akpek EK, Klimava A, Thorne JE, Martin D, Lekhanont K, Ostrovsky A (2009) Evaluation of patients with dry eye for presence of underlying Sjogren’s syndrome. Cornea 28:493–497

    PubMed Central  PubMed  Article  Google Scholar 

  13. Doughty MJ, Fonn D, Richter D, Simpson T, Caffery B, Gordon K (1997) A patient questionnaire approach to estimating the prevelance of dry eye symtoms in patients presenting to optometric practices across Canada. Optom Vis Sci 74:624–631

    CAS  PubMed  Article  Google Scholar 

  14. Rhee DJ, Mark FP (1999) Keratokonjunctivitis sicca. Cornea 55–56

  15. Tseng SCG, Tsubota K (1997) Important concepts for treating ocular surface and tear disorders. Am J Ophthalmol 124:825–835

    CAS  PubMed  Article  Google Scholar 

  16. Prummel M, Mourits M, Berghout A (1989) Prednisone and cyclosporine in the treatment of severe Graves’ ophthalmopathy. N Engl J Med 321:1353–1359

    CAS  PubMed  Article  Google Scholar 

  17. Nussenblatt R, Palestine A, Chan C et al (1991) Randomized, double-masked study of cyclosporine compared to prednisolone in the treatment of endogenous uveitis. Am J Ophthalmol 112:138–146

    CAS  PubMed  Google Scholar 

  18. Georganas C, Iokimidis D, Iatrou C et al (1996) Relapsing Wegener’s granulomatosis: successful treatment with cyclosporine A. Clin Rheumatol 15:189–192

    CAS  PubMed  Article  Google Scholar 

  19. Perry HD, Solomon R, Donnenfeld ED et al (2008) Evaluation of topical cyclosporine for the treatment of dry eye disease. Arch Ophthalmol 126:1046–1050

    PubMed  Article  Google Scholar 

  20. Coster DJ, Shepherd WF, Fook TC et al (1979) Prolonged survival of corneal allografts in rabbits treated with cyclosporine A. Lancet 2:688–689

    CAS  PubMed  Article  Google Scholar 

  21. Nochez Y, Denoyer A, Pisella PJ (2009) 0.05% cyclosporine A for treatment of chronic severe ocular surface disease. Can J Ophthalmol 44:406–411

    PubMed  Article  Google Scholar 

  22. Yoshida A, Fujihara T, Nakata K (1999) Cyclosporine increase tear fluid secretion via release of sensory neurotransmitters and muscarinic pathway in mice. Exp Eye Res 68:541–546

    CAS  PubMed  Article  Google Scholar 

  23. Utine CA, Akpek EK (2010) Clinical Review: topical ophthalmic use of cyclosporin A. Ocul Immunol Inflamm 18:352

    CAS  PubMed  Article  Google Scholar 

  24. Gunduz K, Ozdemir O (1994) Topical cyclosporine treatment of keratokonjonktivitis sicca in secondary Sjogren’s syndrome. Acta Ophthalmol 72:438–442

    CAS  Article  Google Scholar 

  25. Toker E, Acar N, Kazokoğlu H (2003) Sjögren sendromuna bağlı kuru göz hastalığında %0.1 siklosporin A tedavisinin etkinliği. Türk Oftalmoloji Gazetesi 33:324–330

    Google Scholar 

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Correspondence to Senol Kobak.

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Devecı, H., Kobak, S. The efficacy of topical 0.05 % cyclosporine A in patients with dry eye disease associated with Sjögren’s syndrome. Int Ophthalmol 34, 1043–1048 (2014). https://doi.org/10.1007/s10792-014-9901-4

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  • DOI: https://doi.org/10.1007/s10792-014-9901-4

Keywords

  • Sjögren’s syndrome
  • Keratoconjunctivitis sicca
  • Cyclosporine A