Add a first-line prescription corticosteroid to your DED toolbox

Here, the author answers questions about a new therapy, based on firsthand experience with it.

What makes EYSUVIS unique?

EYSUVIS (Kala Pharmaceuticals) is loteprednol etabonate ophthalmic suspension 0.25%, approved in October 2020 for the short-term (up to two weeks) treatment of the signs and symptoms of dry eye disease (DED). For example, a patient who is using artificial tears with limited relief while still experiencing episodic dry eye flares throughout the year can benefit.

The product is a C-20 ester-based corticosteroid with broad-spectrum anti-inflammatory activity. Corticosteroids affect multiple signaling cascades and inflammatory pathways known to attenuate the innate and adaptive immune responses.^1-3

EYSUVIS is unique in that it utilizes AMPPLIFY, Kala Pharmaceuticals’ proprietary mucus-penetrating particle (MPP) drug-delivery technology. These nanoparticles — ~ 300 nm diameter in size — are coated to facilitate penetration of the mucus barrier that allows the drug to spread more uniformly on the ocular surface to achieve longer retention.⁴

Are there any contraindications?

EYSUVIS is contraindicated in most viral diseases of the cornea and conjunctiva, including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella and in mycobacterial infection of the eye and fungal diseases of ocular structures.

What patient feedback have you received?

The rapid onset of symptom relief is impressive for both the patient and the prescribing eye care provider. Patients have been reporting the therapy is tolerable upon instillation. Additionally, copay cards and other support for patient access is made available by Kala (see eysuvis.com/patient-access ).

What benefits does the product provide to your practice?

As we know, a chronic DED patient who is having flares but not experiencing relief will usually “doctor jump.” We can now improve these patients’ outcomes through education about the drug’s mechanism of action and prescribing this treatment, which is specifically indicated to address the signs and symptoms of DED. One happy DED patient may yield multiple patients coming into the practice, based on that word-of-mouth referral.

How do you discuss EYSUVIS with patients?

The conversation starts on our intake form: “Do you ever have a period of time where there is increased awareness of your eyes lasting for more than two days and up to a couple of weeks?”

To my patients already diagnosed, I explain that DED is chronic in nature, but that does not have to mean continuous symptoms. I relate there will be periods of worsening symptoms, called dry eye flares, that could be brought on by environment or activity (e.g., digital screen time, contact lens wear, allergies, A/C use or medications). I ask, “have you ever experienced these?” If the answer is “yes,” I let them know we have a therapy for treating it. This explanation is very well-received by my patients.

To my newly diagnosed DED patients, I ask them to call me if they experience days during which their eyes feel worse. I have found that patients who have DED flares are the ones who truly fear their symptom exacerbations: Their eyes are miserable; they are out of commission for a week, and they do not ever want to feel like that again. Now, we know we can help and reassure them with this short-term treatment. OM

REFERENCES

1. Perez VL, Stern ME, Pflugfelder SC. Inflammatory basis for dry eye disease flares. Exp Eye Res. 2020;201:108294. doi: 10.1016/j.exer.2020.108294
2. Tsubota K, Pflugfelder SC, Liu Z, et al. Defining Dry Eye from a Clinical Perspective. Int J Mol Sci. 2020;21(23):9271. doi: 10.3390/ijms21239271
3. Rhen T, Cidlowski JA. Antiinflammatory action of glucocorticoids--new mechanisms for old drugs. N Engl J Med. 2005;353 (16): 1711–23. doi:10.1056/NEJMra050541. doi: 10.1056/NEJMra050541
4. Popov A. Mucus-Penetrating Particles and the Role of Ocular Mucus as a Barrier to Micro- and Nanosuspensions. J Ocul Pharmcol Ther. 2020; 36(6): 366-375. doi: 10.1089/jop.2020.0022.

DR. O’DELL is regional clinical director of Medical Optometry America, in York, Pa. She also serves as TFOS Global Ambassador. Contact her at helpmydryeyes@gmail.com. Financial disclosure: consultant to Allergan, Eye Eco, EyeDetech, Johnson & Johnson Vision, Kala Pharmaceuticals, Novartis, OysterPoint, Sun, SightSciences, and Tarsus.