BLOG: Fast relief with Miebo: Speed Racer, MD, treats dry eye
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Key takeaways:
- In the KALAHARI trial, subjects gave high scores for Miebo instillation comfort.
- Meaningful symptom improvement occurred 3 days after beginning treatment.
’Twas a time, not so very long ago, when eye doctors treating dry eye disease had heart-to-hearts about how we should discuss the latency between onset of treatment and when patients would finally begin to feel some relief.
We bandied about tricks of the trade for fighting early drug side effects that further eroded our patients’ resolve. Sure, we could use a steroid to handle side effects and accelerate relief, but convention required extra vigilance (ie, office visits) to monitor IOP, a burden for patients and for many offices a disincentive to treat dry eye disease (DED).
You felt like a taxi driver taking a passenger late for a flight on a road with a 20 MPH speed limit, speed bumps and sinkholes you had to avoid.
Times have changed. We now have two immunomodulators with phase 3 FDA data showing early effectiveness beginning at 2 weeks (Xiidra, lifitegrast ophthalmic solution 5%, Bausch + Lomb) to 4 weeks (Vevye, cyclosporine ophthalmic solution 0.1%, Harrow). Still, except for steroids, up until now we have been missing that “wow” treatment that works nearly right out of the chute. As with many FDA trials, the Miebo GOBI, MOJAVE and KALAHARI trials contained a treasure trove of data in addition to the primary and secondary endpoints. B+L dove into data that looked at the very early effects of Miebo (perfluorohexyloctane ophthalmic solution, Bausch + Lomb), as well as its safety and tolerability. The results, presented at a recent Tear Film & Ocular Surface Society conclave, were stunning.
It's a smooth, comfortable ride with Miebo. In pooled data from GOBI and MOJAVE, comfort and satisfaction were seen at the 3-day mark (83%) and increased at both day 7 (86%) and day 14 (90%). At 12 months, KALAHARI subjects rated instillation comfort highly, with more than 80% scoring it as 7 to 10 out of 10 overall. More granular data at 1 year were equally impressive: comfort (8.4/10), ease of administration (8.9/10), overall satisfaction (8/10) and the likelihood of asking for a script (7.9/10). Miebo is comfortable early and remains so over the 12 months it was studied.
What about DED symptoms? As with most phase 3 studies now, symptoms were measured using the visual analogue scale/dry eye in which 0 means no symptoms and 100 means that symptoms are so bad you can’t think of anything else. Subjects were queried about symptom frequency at baseline and days 3, 7 and 14. The results are unprecedented for nonsteroid treatment of DED: The most bothersome symptom score was 77.9 at baseline, 46.7 at 3 days, 41.3 at 7 days and 34.7 at 14 days (a 55% decrease). Awareness of DED was 77.6 at baseline, 39.7 at 3 days, 32.6 at 7 days and 27.6 at 14 days (a 64% decrease). Fluctuating vision scores were 62.8 at baseline, 29.8 at 3 days, 24.5 at 7 days and 19.4 at 14 days (a 69% decrease). All three measures had meaningful symptom improvement in 3 days; fluctuating vision improved by 52.5% after 3 days of treatment.
Three. Comfortable. Days.
These are all meaningful changes in symptoms. They all began to improve as soon as day 3, continuing to improve over the course of the first 2 weeks of treatment. It goes without saying that this is without precedent in DED care, at least when it comes to nonsteroid treatment. Where once we had no treatments that directly treated evaporation, we now have a way to treat evaporative DED quickly and comfortably. I feel like Speed Racer test driving the Mach 9 race car:
“I’ve entered a whole new dimension. A dimension of speed!”
Reference:
- McDonald M, et al. Perfluorohexyloctane ophthalmic solution instillation comfort and eye drop acceptability: Patient-reported outcomes in phase 3 clinical studies. Presented at: Tear Film & Ocular Surface Society conference; Oct. 30-Nov. 2, 2024; Venice, Italy.
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