Dextenza relieves itching from allergic conjunctivitis
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Dextenza may relieve ocular itching in patients with allergic conjunctivitis for up to 4 weeks, according to a study published in American Journal of Ophthalmology.
“Because of the wide variability in allergens and in individuals’ responses to these allergens, environmental studies can introduce bias in the evaluation of potential ocular therapies,” the study authors wrote. “The standard Ora-CAC (conjunctival allergen challenge) model, on the other hand, reproducibly induces an acute moderate to severe ocular allergic reaction so that potential therapies can be studied for their impact in relieving signs and symptoms associated with the early phase of the allergic response.”
Patients were randomly assigned to receive either Dextenza (dexamethasone ophthalmic insert 0.4 mg, Ocular Therapeutix) (35 patients) or a placebo insert (38 patients). After placement, CACs were conducted at weeks 1, 2 and 4. The primary endpoints, which were observed at the week 1 CAC day 8, were subject-reported ocular itching at 3, 5 and 7 minutes post-CAC and investigator-evaluated conjunctival redness at 7, 15 and 20 minutes post-CAC, according to the study.
The authors found that patients treated with dexamethasone had lower mean ocular itch scores compared with placebo at all time points (P < .001). Patients treated with dexamethasone also had lower conjunctival redness scores at 20 minutes (P < .05) but not at 7 or 15 minutes. There was less itching and conjunctival redness with dexamethasone at 31 and 29 of 33 time points, respectively (P < .05).
There were no reports of serious adverse events.
“These data demonstrate the potential for a single, hands-free, physician-administered, preservative-free dexamethasone intracanalicular insert treatment to provide relief of signs and symptoms of allergic conjunctivitis for up to 4 weeks in subjects with allergic conjunctivitis, while maintaining a favorable safety profile,” the authors wrote.
Perspective
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Steven M. Silverstein, MD, FACS
For a very long time, steroids have been used with caution for allergic conjunctivitis because of the potential for steroid abuse, as well as the potential use with an incorrect diagnosis. For example, you would not want to accidentally diagnose epidemic keratoconjunctivitis or adenovirus as allergic conjunctivitis in certain patients on steroids. More significantly, you would not want to miss herpes simplex and start treating it with a steroid. For those primary reasons, we have reserved steroids for the more advanced or recalcitrant cases of allergic conjunctivitis.
Considering the eluting of steroids over the release for a single Dextenza implant, it is an excellent opportunity now to use a steroid safely and for a time-limited course. That way, the patients will not overuse the steroid or use it longer than the doctor initially intended. It really is an excellent opportunity either as a stand-alone or as an adjunct to one of the allergy nonsteroidal medications that have been on the market for years.
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