Restasis-Systane Combination Superior to Refresh-Systane in Treating Chronic Dry Eye Syndrome: Presented at AAO

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Title: Restasis-Systane Combination Superior to Refresh-Systane in Treating Chronic Dry Eye Syndrome: Presented at AAO
URL: http://www.pslgroup.com/dg/2173E2.htm
Doctor's Guide
November 15, 2007

By Cameron E. Johnston

NEW ORLEANS, LA -- November 15, 2007 -- Combination therapy using Restasis (cyclosporine A) together with Systane eye drops appears to be superior to Systane alone, or to Restasis plus Refresh Tears, for improving the signs and symptoms of dry eye syndrome, researchers reported here at the annual meeting of the American Academy of Ophthalmology (AAO).

Dry eye syndrome is a multifactorial disease, with multiple treatments available. However, as with most medical conditions, treatments usually have to be tailored to the individual patient, and some trial and error for finding the best therapy will usually be required, said Dr. Roy Chuck, Director of Refractive Surgery, Wilmer Eye Institute, Baltimore, Maryland, United States.

There are numerous underlying causes of dry eye, including (but not limited to) pemphigoid, Stevens-Johnson syndrome, lipid deficiencies, mucin deficiency, lupus, inflammation, Dr. Chuck said in a late-breaking symposium on November 13.

Factors that influence dry eye can range from the patient's age to thyroid problems, and whether the patient has had laser-assisted in situ keratomileusis (LASIK) surgery. Overuse of computers, too much TV-watching, and the use of many systemic medications can contribute to the problem.

"Dry eye is a chronic condition and Restasis is a chronic therapy, and not usually a cure," Dr. Chuck said in his presentation.

In one study he described, patients were randomised to receive either Restasis twice daily together with Refresh Tears at least once daily (n=20), or Restasis twice daily plus Systane at least once daily (n=20), or Systane alone (n=20) at least four times per day. Patients were followed for 6 months.

At the 6-month evaluation, there was a statistically significant difference in corneal staining between patients who received Restasis-Systane and those who received Restasis-Refresh Tears (P =.048). There was also a trend toward increased tear-film break-up time at 6 months in favour of the Restasis-Systane. Significant differences were seen favouring Restasis-Refresh for ocular burning, dryness, stinging and grittiness. Systane alone was significantly better than Restasis-Refresh in terms of less burning, dryness and scratchiness.

These findings show that both adjunctive therapies were compatible with Restasis, but the combination of Systane-Restasis was better overall, Dr. Chuck said.

Nonetheless, he said that neither therapy should be considered as first-line treatment, and should only be used after the patient has failed therapies with artificial tears alone, omega-3 fatty acids, doxy- or minocycline, and tear drainage plugs. If and when Restasis is needed, it should be used in sequential combination with artificial tears, he said.

At this time, Restasis (cyclosporine A) is the only prescription drug approved to treat dry eye, but its initial benefits are not seen until after 1 month of use, with increasing improvement over the next 3 months. It may take up to 6 months to be completely effective, Dr. Chuck said.

[Presentation: Dry Eyes - When Restasis Is Not Enough. Late Breaker]

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