Immunomodulator can conquer vernal keratoconjunctivitis

Angela Zhu, MD, an ophthalmologist at Bascom Palmer Eye Institute in Miami, recalls seeing an 8-year-old boy who suffered through 3 or 4 flares of vernal keratoconjunctivitis (VKC) over two years. When Verkazia (cyclosporine ophthalmic emulsion 0.1%, Santen) became available, she says she prescribed it to the boy, who has since had no recurrences of the insufferable condition. Verkazia is FDA approved for the treatment of VKC in children and adults.

“Verkazia is useful for patients who have had multiple flares of VKC, or who have already had complications from the condition, such as corneal ulceration or scarring,” Dr. Zhu explains.

Here, Dr. Zhu, along with two other ophthalmologists who have experience in prescribing the drug, further discuss its benefits.

Delivery

Verkazia is comprised of proprietary cationic ophthalmic emulsion technology that increases cyclosporine bioavailability in the cornea and inhibits chronic inflammation in both children and adults who have VKC. Specifically, it works by embedding cyclosporine in positively charged (cationic) nanosized droplets, which then electrostatically bond with the negatively charged (anionic) ocular surface.

Beeran B. Meghpara, MD, co-director of the refractive surgery department at Wills Eye Hospital, in Philadelphia, says he appreciates the unique vehicle used to make the drug available to the cornea.

“The nanosized cationic droplets help increase penetration of the medication to the ocular surface,” he says. “The vehicle increases bioavailability and concentration of cyclosporine in the ocular surface.”

Efficacy

Simon Fung, MD, an ophthalmologist at the UCLA Stein Eye Institute, in Los Angeles, says Verkazia lives up to its efficacy, as reported in the literature.

Specifically, he says his VKC patients responded to the drug positively within four weeks of use, something revealed in the The VErnal KeratoconjunctiviTIs Study (VEKTIS). This was a phase 3, multicenter, double-masked, vehicle-controlled trial on pediatric patients ages 4 to 17 who had active, severe VKC (grade of 3 or 4 on the Bonini severity scale) and major keratitis (corneal fluorescein staining score of 4 or 5 on the modified Oxford scale).

“With studies showing the efficacy of Verkazia without concurrent steroid usage even for active severe VKC, I turn to the drug much earlier, and I’m able to reduce steroid use over the medium- and long-term,” Dr. Fung notes.

A Welcomed Addition

“I have a patient in his late teens who developed significant pain, discomfort, and ocular surface inflammation every time I tried to taper him off his steroids,” Dr. Fung points out. “After I started him on Verkazia, I was able to stop the steroid completely for an extended period. He eventually did have a flare up, but required only a short, 2-week course of steroids to regain control.” CP