CEQUA: Cyclosporine Reimagined
Dry eye experts discuss the clinical trial data and the unique composition of CEQUA (cyclosporine ophthalmic solution) 0.09% that are changing their prescribing practices.
Darrell White, MD; Doug Devries, OD; Selina R. McGee, OD, FAAO; Brandon Ayres, MD; Josh Johnston, OD, FAAO; and Jai G. Parekh, MD, MBA, FAAO
Cataract and Refractive Surgery Today
h1 sup { font-size: 50%; top: -0.6em; } Darrell White, MD: We have convened this panel of ophthalmologists and optometrists to share our viewpoints about the state of dry eye disease (DED) and, specifically, how a topical formulation, CEQUA (cyclosporine ophthalmic solution) 0.09% (Sun Ophthalmics) fits into our varied practices. In this roundtable, we will discuss the challenges of patient discontinuation and the clinical need for a topical DED therapy that is comfortable, tolerable, and efficacious for patients. THE PREVALENT PROBLEM OF DED Dr. White: Whenever we talk about DED, it’s important to define it. DED is a multifactorial, immune-mediated inflammatory disorder of the ocular surface.1,2 It is characterized by a loss of tear film homeostasis, which ignites inflammatory cytokines that interrupt the natural feedback loop between the ocular surface, specifically the lacrimal functional unit, the lacrimal glands, goblet cells, meibomian glands, and the brainstem.1-5 A negative feedback loop begins: inflammation begets dryness, which begets inflammation, which begets dryness, and this cycle progressively worsens. The three mainstay pharmaceutical options to treat this DED cycle include CEQUA (cyclosporine ophthalmic solution) 0.09%, Restasis® (cyclosporine ophthalmic emulsion) 0.05% (AbbVie/Allergan, Inc.), and Xiidra® (lifitegrast ophthalmic solution) 5% (Bausch + Lomb).1 These are all anti-inflammatory agents, all indicated for the long-term treatment of DED, and they are also immunomodulators that work differently from ocular steroids and the older anti-inflammatories. THE CHALLENGE OF PATIENT ADHERENCE TO DED MEDICATION Dr. White: The entirety of the DED pharmaceuticals market suffers from low patient adherence. There are high rates of discontinuation of dry eye therapies in general, but specifically with immunomodulators. In a study that colleagues and I conducted in 2019, we showed that the majority of patients who were on Restasis and Xiidra discontinued the treatments within 12 months.6 Having used these medications in our practices, we can all attest that they can cause burning and stinging upon instillation.7 Additionally, there can be significant lag time between patients’ initiating treatment and when they experience symptomatic relief.6 Yet, when patients discontinue their treatments, DED can progress and become more complex.