An Updated Systematic Review With Meta-Analysis Of Randomized Trials On Topical Cyclosporin A For Dry-Eye Disease

Abstract

Background/Aims

To evaluate the effects of topical cyclosporin A (CsA) and artificial tears (ATs) for treating patients with dry-eye disease (DED).

Methods

On January 25, 2019, five electronic databases and reference lists were searched for randomized clinical trials (RCTs) comparing CsA with ATs among patients with DED. The search strategy had no restriction on language or time. Two authors extracted surgery, mean age, anesthesia for Schirmer’s test, tear-breakup time, Schirmer’s test score, fluorescein-staining score, ocular surface–disease index, and adverse events. Mean differences (MDs) were calculated for continuous outcomes and Peto ORs for dichotomous data with zero cells. Results were analyzed with 95% CIs in a random-effect model.

Results

Eleven RCTs recruiting 1,085 cases with DED were included. Pooled results showed that CsA had better tear-breakup time (MD 0.94, 95% CI 0.08–1.80), fluorescein-staining score (standardized MD −0.72, 95% CI −1.28 to −0.16), and ocular surface–disease index (MD −4.75, 95% CI −6.31 to −3.18) when compared to ATs. Although CsA had more adverse events than ATs (Peto OR 7.70, 95% CI 3.17–18.68), no serious adverse events were reported.

Conclusion

Overall, CsA is an effective option for treating patients with DED, yet our evidence indicated decreasing effects when CsA was combined with ATs. CsA may be worth suggesting to relatively older patients with DED. We anticipate further RCTs to explore the effects of treatment duration, optimal dosage, and efficacy of CsA in different DED etiology.

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Keywords:

• dry eye
• cyclosporin A
• meta-analysis

Abbreviations

CsA, cyclosporin A; DED, dry-eye disease; WMD, weighted mean difference; OSDI, ocular surface–disease index; RCT, randomized clinical trial; TBUT, tear-breakup time.

Author Contributions

HIT systematically identified evidence, critically appraised the included articles, acquired data, managed data, and drafted the first version of the manuscript. SCC supervised the research and critically revised the manuscript. YNK designed the study, systematically identified evidence, analyzed the data, interpreted the results, and drafted the first version of the manuscript. All authors contributed to data analysis and drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

Dr Kang’s current affiliations are at the Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University and Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taiwan. The authors declare that they have nothing to disclose regarding funding or conflicts of interest with respect to this work.