A review of dry eye disease therapies: exploring the qualities of varenicline solution nasal spray

ABSTRACT

Introduction

Dry eye disease is a prevalent, multifactorial disease characterized by loss of tear film homeostasis. A myriad of ocular therapeutics is commercially available and in development for personalized management of dry eyes. Recently, Varenicline solution nasal spray (VNS) received approval from the US Food and Drug Administration for the treatment of dry eyes.

Areas covered

This review explores the current mainstay treatments for dry eyes and the role of VNS in addressing unmet needs in the treatment of dry eye disease. A PubMed and MEDLINE keyword search on Tyrvaya and Varenicline nasal solution spray was performed as a part of the inclusion criteria. Varenicline solution nasal spray has been shown to be well tolerated and demonstrated to provide clinically significant improvement in patients with dry eyes

Expert opinion

Treatment of dry eye disease with VNS may be most beneficial in patients with limited upper-body mobility, dexterity issues, tremors, and glaucoma.

KEYWORDS:

• Dry eye syndromes
• nasal spray
• nicotinic acetylcholine receptor
• pharmacologic neuroactivator
• varenicline
• varenicline nasal spray

Article highlights

• Dry eye disease is a chronic, persistent, multifactorial disease that requires a personalized, nuanced approach.

• Varenicline nasal solution spray (VNS) is a selective nACh receptor partial agonist with a high affinity to nACh receptors on the Trigeminal nerve endings, which are scattered through the nasal cavity epithelium.

• VNS demonstrated clinical improvement of DED with anesthetized Schirmer’s Tear Test measurements and Eye Dryness score clinical endpoints. Response was noted as early as 5 min following administration.

• VNS has a favorable safety profile.

• VNS would most likely be most beneficial for patients with limited upper-body mobility, cervical issues, dexterity limitations, limited manual strength, proprioception difficulties, tremors, cosmetic make-up concerns, and glaucoma on topical therapy.

Declaration of interest

John Sheppard is a consultant to Allergan, Alcon, Bausch & Lomb, Dompe, Oyster Point, Sun Pharma, Novaliq, and Mallinckrodt. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.