Topical cyclosporine for atopic keratoconjunctivitis

Area of Science:

• Ophthalmology
• Immunology
• Dermatology

Background:

• Atopic keratoconjunctivitis (AKC) is a chronic, non-infectious inflammatory eye condition associated with atopic dermatitis.
• AKC can lead to corneal complications and often requires long-term management.
• Topical corticosteroids are standard treatment but have potential side effects; topical cyclosporine A (CsA) is explored as an alternative or adjunct.

Purpose of the Study:

• To evaluate the efficacy of topical CsA in treating AKC.
• To gather evidence on the safety of topical CsA from randomized controlled trials (RCTs).
• To assess CsA's potential as a corticosteroid-sparing agent in AKC management.

Main Methods:

• A systematic search of multiple electronic databases (CENTRAL, MEDLINE, EMBASE, LILACS, CINAHL, OpenGrey, mRCT, ClinicalTrials.gov, ICTRP, IFPMA, Web of Science) was conducted.
• Handsearching of relevant conference proceedings was also performed.
• Only randomized controlled trials (RCTs) were included in the review.

Main Results:

• Three RCTs with 58 participants were included, showing significant variability in interventions and outcomes.
• One study indicated beneficial effects of topical CsA on AKC signs and symptoms; another showed benefits for signs only; one showed no improvement.
• Evidence on CsA reducing topical steroid use was mixed; no serious adverse events were reported, but small sample sizes limited safety assessment.

Conclusions:

• Evidence on the efficacy and safety of topical CsA for AKC is limited due to a scarcity of well-designed trials.
• Topical CsA may offer clinical and symptomatic relief and potentially reduce topical steroid dependence in AKC patients.
• Further large-scale, well-designed RCTs are necessary to definitively establish the efficacy and safety profile of topical CsA in AKC.