Loteprednol a first-line therapy for seasonal allergic conjunctivitis

"Nothing quiets an inflamed eye faster than a corticosteroid, and no other anti-allergy option is as effective as a corticosteroid in relieving the full spectrum of signs and symptoms of SAC," said Dr. McCabe, a private practitioner in Murfreesboro, TN, and clinical adjunct faculty, Department of Ophthalmology and Visual Sciences, Vanderbilt University, Nashville, TN. "With loteprednol etabonate 0.2%, ophthalmologists can provide [patients with SAC who are] suffering from significant distress with the benefits of a corticosteroid, but with greater confidence about safety."

Improvement in signs, symptoms

"Patients who use loteprednol etabonate benefit with improvement in chemosis, foreign body sensation, burning, stinging, and tearing as well as erythema and itching," Dr. McCabe said.

Based on this activity, Dr. McCabe said he considers the topical corticosteroid as a first-line option for patients who suffer from a broader array of SAC-related signs and symptoms. In addition, because of its superior ability to relieve redness, he said he favors loteprednol etabonate 0.2% as his agent of choice for patients whose primary complaint is more moderate-to-severe redness and/or itching.

"Any time patients are having a more moderate-to-severe flare of their SAC, it is a good time to start using loteprednol etabonate 0.2%," Dr. McCabe said.

Once the flare is controlled, the treatment often can be transitioned to an antihistamine or one of the dual-acting anti-allergy agents. However, some highly allergic patients may need longer maintenance with the corticosteroid. In that situation, Dr. McCabe said he feels comfortable continuing loteprednol etabonate because of its established safety profile.

"Results from clinical trials demonstrate that loteprednol etabonate 0.2% has a better safety profile than other corticosteroids, and the difference is explained by its unique chemical structure," he said. "Loteprednol etabonate is an ester-corticosteroid that only becomes activated when bound to the steroid receptor, and then it is rapidly inactivated.

"In a study where patients were treated for up to 3 years, there was no difference between the placebo-treated controls and patients using loteprednol etabonate 0.2% in the occurrence of IOP elevations, infection, or cataract formation," Dr. McCabe added. "However, all patients who are receiving loteprednol etabonate for a longer period should have their IOP monitored periodically and be counseled to call for an appointment if they develop blurred vision, discharge, red eye, or ocular pain."

Another benefit of loteprednol etabonate 0.2% is that it is formulated with two moisturizing agents, povidone and glycerin, so that the drop is extremely comfortable.

"Patients with SAC have irritated eyes and many have concomitant dry eye disease," Dr. McCabe concluded. "The vehicle used for loteprednol etabonate provides a soothing effect on instillation and can help relieve dry eye-related symptoms as well."

FYI

Craig McCabe, MD, PhD, FACS
E-mail: drmccabe@mccabevisioncenter.com

Dr. McCabe has served as a speaker for Alcon Laboratories, Bausch + Lomb, Inspire Pharmaceuticals, ISTA Pharmaceuticals, Odyssey Medical, and Pfizer. http://www.McCabeVisionCenter.com/