A Randomized, Controlled Trial of Cyclosporine A Cationic Emulsion in Pediatric Vernal Keratoconjunctivitis: The VEKTIS Study.

Abstract

PURPOSE:

Vernal keratoconjunctivitis (VKC) is a chronic, allergic, and potentially severe ocular disease affecting children and adolescents that can lead to impaired quality of life (QoL) and loss of vision. This study evaluated the efficacy and safety of an investigational therapy for severe VKC, cyclosporine A (CsA) cationic emulsion (CE), an oil-in-water emulsion with increased bioavailability versus conventional CsA formulations.

DESIGN:

The VErnal KeratoconjunctiviTIs Study (VEKTIS) is a phase 3, multicenter, double-masked, vehicle-controlled trial.

PARTICIPANTS:

Pediatric patients (4 to younger than 18 years) with active severe VKC (grade of 3 or 4 on the Bonini severity scale) and severe keratitis (corneal fluorescein staining [CFS] score of 4 or 5 on the modified Oxford scale).

METHODS:

One hundred sixty-nine patients were randomized to CsA CE 0.1% (1 mg/ml) eye drops 4 times daily (high dose), CsA CE twice daily (low dose) plus vehicle twice daily, or vehicle 4 times daily for 4 months.

MAIN OUTCOME MEASURES:

The primary end point was a mean composite score that reflected CFS, rescue medication use (dexamethasone 0.1% 4 times daily), and corneal ulceration over the 4 months.

RESULTS:

Differences in least-squares means versus vehicle for the primary end point were statistically significant for both the high-dose (0.76; P = 0.007) and the low-dose (0.67; P = 0.010) groups, with treatment effect mainly driven by CFS score. Significant differences were found between both active treatment groups and vehicle for use of rescue medication. Vernal keratoconjunctivitis symptoms and patient QoL (assessed by visual analog scale and the Quality of Life in Children with Vernal Keratoconjunctivitis questionnaire) improved in all 3 groups, with significant improvements for high-dose CsA CE versus vehicle.

CONCLUSIONS:

The efficacy of high-dose CsA CE in improving keratitis, symptoms, and QoL for those with severe VKC was demonstrated in these study patients. In addition, in this study cohort, CsA CE was well tolerated.

• Authors: Andrea Leonardi, Serge Doan, Mourad Amrane, Dahlia Ismail, Jesús Montero, János Németh, Pasquale Aragona, Dominique Bremond-Gignac, VEKTIS Study Group
• Journal: Ophthalmology (Ophthalmology) Vol. 126 Issue 5 Pg. 671-681 (05 2019) ISSN: 1549-4713 [Electronic] United States
• PMID: 30593775 (Publication Type: Clinical Trial, Phase III, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Chemical References

• Emulsions
• Glucocorticoids
• Immunosuppressive Agents
• Ophthalmic Solutions
• Dexamethasone
• Cyclosporine

Topics

• Adolescent
• Child
• Child, Preschool
• Conjunctiva (drug effects, pathology)
• Conjunctivitis, Allergic (diagnosis, drug therapy)
• Cyclosporine (administration & dosage)
• Dexamethasone (administration & dosage)
• Dose-Response Relationship, Drug
• Double-Blind Method
• Drug Administration Schedule
• Emulsions (administration & dosage)
• Female
• Follow-Up Studies
• Glucocorticoids (administration & dosage)
• Humans
• Immunosuppressive Agents (administration & dosage)
• Male
• Ophthalmic Solutions
• Quality of Life
• Retrospective Studies
• Treatment Outcome