Topical agent offers rapid, sustained relief of itching from allergic conjunctivitis

Issue: October 25, 2011

An eye drop for the treatment of allergic conjunctivitis is well-tolerated and has shown good results, according to an ophthalmologist who has adopted the drug.

Lastacaft (alcaftadine ophthalmic solution, 0.25%, Allergan) was approved by the U.S. Food and Drug Administration for the prevention of itching associated with allergic conjunctivitis in August 2010. Allergan launched the drug in January.

“So far, it’s been fairly positive,” Rajesh K. Rajpal, MD, OSN Refractive Surgery Board Member, said. “The patients have generally been fairly comfortable with it. There are a very small percentage of the patients who have had some irritation or discomfort, but most of them have been pleased with the effect of it.”

Alcaftadine is a topical H1 histamine receptor antagonist. The approved dosing regimen is one drop in each eye once daily.

The agent has no contraindications. Patients are advised to refrain from wearing a contact lens if their eye is red. In addition, patients are advised not to instill the drop while wearing contact lenses. Contact lenses should be removed before administration of the drop and may be reinserted 10 minutes after administration, according to an FDA document.

“I tell contact lens patients to put it in before they put their lenses in or after they take them out,” Dr. Rajpal said.

Most of the patients in his practice so far treated with alcaftadine were adults with seasonal allergic conjunctivitis, Dr. Rajpal said.

Alcaftadine has compared favorably with other topical anti-allergic agents, Dr. Rajpal said.

“The majority of the patients could not tell a huge difference between this and other allergy drops they’ve tried in the past. They like the once-a-day convenience if they have been using something else that was twice a day before,” he said.

Many patients with allergic conjunctivitis also suffer from dry eye, blepharitis and other ocular surface diseases, Dr. Rajpal said. Most of these patients may continue treatments such as Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan), Azasite (azithromycin ophthalmic solution 1%, Merck), artificial tears and punctal plugs while receiving alcaftadine, he said.

“There hasn’t been any negative to using both together, and I do think it’s important to treat all components of ocular surface disease, so I will treat patients with multiple agents as necessary,” Dr. Rajpal said. “If patients have severe allergic conjunctivitis symptoms, I’ll put them on a steroid as well. It’s nice to be able to add something like Lastacaft as well to manage that and treat that and prevent it from causing more symptoms and getting worse.”

A phase 3 clinical trial showed alcaftadine to have rapid onset of therapeutic benefit and prolonged action.

The double-masked, multicenter, placebo-controlled study, published in Current Medical Research and Opinion, included 58 patients 10 years of age or older with a history of allergic conjunctivitis. Patients were randomized to receive one drop of alcaftadine 0.25% or sham treatment bilaterally.

A conjunctival allergen challenge was used to induce signs and symptoms of allergic conjunctivitis. Ocular itching was assessed up to 7 minutes and conjunctival redness was assessed up to 20 minutes after the challenge.

Study results showed that alcaftadine markedly reduced conjunctival redness and most other allergic signs and symptoms at 15 minutes and at 16 hours after drop instillation, the authors said.

No significant safety issues were identified. – by Matt Hasson

Reference:

Torkildsen G, Shedden A. The safety and efficacy of alcaftadine 0.25% ophthalmic solution for the prevention of itching associated with allergic conjunctivitis. Curr Med Res Opin. 2011;27(3):623-631.

Rajesh K. Rajpal, MD, can be reached at See Clearly Vision Group, 8138 Watson Street, Mclean, VA 22102; 703-287-4122; email: rrajpal@seeclearly.com.

Disclosure: Dr. Rajpal is a consultant to Allergan, Alcon, and Ista Pharmaceuticals.