Combine Efficacy and Safety
Eye doctors have a new option for treating inflammatory eye conditions. How will this combination drug benefit your practice?

Optometrists are becoming more comfortable prescribing combination steroid and antibiotic drugs, especially since they've come to understand the role of inflammation in many ocular conditions. Steroids reduce inflammation, while antibiotics control or reduce the risk of infection.

Anticipating FDA approval of combination loteprednol etabonate 0.5% and tobramycin 0.3% (Zylet), a group of eye doctors gathered to discuss when and how they use steroid/anti-infective agents in their practices. In addition to giving the loteprednol/tobramycin combination high marks for safety and efficacy, they described how this agent meets a previously unmet need for safe drugs to treat chronic conditions. (See "Why is Loteprednol Safer?" on page 4).

Improved safety

When prescribing steroids, practitioners must be aware of potential immediate and long-term adverse effects. Patients who use steroids as needed for chronic conditions are especially at risk.

"Safety is key," says Jimmy D. Bartlett, O.D., F.A.A.O., Birmingham, Ala. "For most conditions, you won't find a significant difference in efficacy between combination loteprednol/tobramycin and
dexamethasone/tobramycin (TobraDex). However, the loteprednol combination is safer, particularly for patients with chronic conditions." Studies^1,2 have shown that loteprednol is less likely to elevate IOP than other steroids, making this agent safe for long-term use -- even for patients with glaucoma.

Loteprednol's improved safety profile also is changing the way doctors prescribe steroids. "I was reluctant to prescribe dexamethasone for chronic blepharitis, but I feel better about prescribing loteprednol," says Walter S. Ramsey, O.D., F.A.A.O., Charleston, W. Va.

Ron Melton, O.D., F.A.A.O., from Charlotte, N.C., points out, "Loteprednol is FDA-approved for the broadest array of indications." Dr. Bartlett agrees, adding, "We can treat any inflammation on-label with loteprednol."

Enhanced efficacy

Tobramycin, the anti-infective component of Zylet, is a good match with loteprednol, explains Randall K. Thomas, O.D., M.P.H., F.A.A.O., Concord, N.C. "Appropriate dosing maintains a high ocular surface concentration," he says. "The millions of doses we've prescribed over the years show this agent is a highly effective antibiotic."

Nevertheless, some optometrists still may prefer to prescribe separate steroids and fourth generation fluoroquinolones for conditions that respond well to combination drugs, Dr. Thomas says. "It's important to understand we're not using tobramycin as a compromise," he says.

Gaining momentum

Combination loteprednol and tobramycin not only is changing how eye doctors treat external eye disease, but also is influencing their choice of combination steroid/anti-infective drugs.

"Given the option of a straight steroid or a safe combination steroid/antibiotic, I think optometrists will reach for the combination first," says Marc R. Bloomenstein, O.D., F.A.A.O., from Phoenix.

References

1. Abelson M, Howes J, George M. The conjunctival provocation test model of ocular allergy: Utility for assessment of an ocular corticosteroid, loteprednol etabonate. J Ocul Pharmacol Ther. 1998;14:533-542.

2. Ilyas H, Slonim CB, Braswell GR, et al. Long-term safety of loteprednol etabonate 0.2% in the treatment of seasonal and perennial allergic conjunctivitis. Eye Contact Lens. 2004;30:10-13.