Peer-reviewed

Topical Cyclosporine in the Treatment of Allergic Conjunctivitis: A Meta-analysis – Corrected Proof

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Purpose: To assess the efficacy and safety of topical cyclosporine versus placebo in the treatment of allergic conjunctivitis.Design: Systematic review and meta-analysis.Participants: Seven qualified studies incorporating 306 eyes of 153 patients were analyzed.Methods: Searches of randomized controlled trials were conducted in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform.Main Outcome Measures: We assessed the methodologic quality of individual included trials and performed meta-analyses using the random effects model if P<0.1 in the test for heterogeneity, or otherwise used the fixed effect model. We assessed scores of composite signs and symptoms, reduction in steroid eye drop use in steroid-dependent patients, and safety outcomes (i.e., stinging or burning sensation).Results: At 2 weeks of follow-up or longer, evidence suggests a statistically significant improvement in the composite signs (standardized mean difference [SMD], −1.21; 95% confidence interval [CI], −1.80 to −0.62; I2 = 71%) and symptoms (SMD, −0.84; 95% CI, −1.51 to −0.16; I2 = 80%) after topical cyclosporine treatment for allergic conjunctivitis regardless of the dosage of treatment. There was a significant reduction (mean difference, −61.16; 95% CI, −101.61 to −20.72; I2 = 58%) in the use of steroid eye drops in patients with steroid-dependent allergic conjunctivitis. Stinging or burning sensation (odds ratio, 2.56; 95% CI, 0.19–35.06; I2 = 73%) was common in both the cyclosporine and placebo groups.Conclusions: This systematic review and meta-analysis suggests topical cyclosporine could be an effective and safe treatment method for allergic conjunctivitis. Further randomized controlled trials with larger sample sizes and standardized outcome measurements, follow-up periods, and cyclosporine concentrations are warranted to determine the short- and long-term efficacy and safety and the minimal effective dosage of topical cyclosporine for allergic conjunctivitis.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.