Corneal staining separates from vehicle by day 28, with benefit maintained through 12 months.
OFF-LABELNot in the FDA label for this product
Moderate to severe dry eye disease in adults, including severe keratitis
One drop once daily, the regimen used in both phase 3 dry eye trials of 0.1% cyclosporine A cationic emulsion
Pooled phase 3 RCTs · n=734
Pooled analysis of SICCANOVE and SANSIKA, two double-masked randomized vehicle-controlled phase 3 trials of 0.1% cyclosporine A cationic emulsion dosed once daily for 6 months in adults (395 on drug, 339 on vehicle): treated patients were more likely to be composite corneal staining plus OSDI responders at month 6, odds ratio 1.66 (95% CI 1.11 to 2.50, P = 0.015), holding in severe dry eye (OR 1.80, 95% CI 1.04 to 3.19, P = 0.038) and in Sjogren's syndrome with severe dry eye (OR 3.37, 95% CI 1.20 to 11.19, P = 0.030) but not in the overall Sjogren's population (OR 1.77, 95% CI 0.89 to 3.66, P = 0.109). Conjunctival HLA-DR expression fell versus vehicle (P = 0.002). Note the mismatch with this label: those trials dosed once daily in adults with dry eye, not QID for vernal disease, and dry eye is not a US-approved indication for this product.
0.1% (1 mg/mL) unpreserved emulsion, 0.3 mL single-dose vials, 5 vials per aluminum pouch, 120-vial box that must be dispensed intact
Mechanism of Action
Calcineurin inhibitor immunosuppressant systemically; after ocular dosing it is thought to act by blocking release of pro-inflammatory cytokines such as IL-2, and the exact mechanism in vernal keratoconjunctivitis is not known. Supplied as a sterile unpreserved milky-white emulsion containing cetalkonium chloride, the cationic oil-in-water emulsion used in the VEKTIS and NOVATIVE trials, with a maximum measured blood level of 0.67 ng/mL on QID dosing out to 12 months.
Warnings & Precautions
Vial tip contamination: Contact between the vial tip and the eye or any other surface risks eye injury and contamination of the emulsion.
Common Side Effects
Ocular, most common: Eye pain 12% and eye pruritus 8%, both including instillation site events, usually transitory and occurring during instillation.
Ocular, 1% to 6%: Ocular discomfort 6% (includes foreign body sensation), visual acuity reduced 5%, ocular hyperemia 4%.
Pregnancy: No adequate and well-controlled studies in pregnant women. Oral cyclosporine was not teratogenic in rats or rabbits at clinically relevant doses; teratogenicity appeared only at maternally toxic oral doses about 320 (rat) and 2150 (rabbit) times the maximum recommended human ophthalmic dose of 0.015 mg/kg/day.
Lactation: Presence in human milk after topical ocular dosing is unknown, as is any effect on the breastfed infant or on milk production; oral cyclosporine given to rats during lactation produced no adverse effects in offspring at clinically relevant doses; weigh the benefits of breastfeeding against the clinical need for treatment.
Pediatric Use
Safety and effectiveness established from 4 through 18 years of age.