Evaluation of the Efficacy and Safety of Tacrolimus Drops in Children With Vernal Keratoconjunctivitis

Vernal keratoconjunctivitis (VKC) is a chronic inflammatory eye disease affecting children and adolescents. It is a disease of allergic origin which, if left untreated, can have a significant impact on quality of life, daily activities and learning. In some cases, sequelae of the disease or complications from the treatments used can lead to permanent vision impairment.

Symptoms of VKC include intense itching, tearing, mucous secretions, burning, foreign body sensation and severe photophobia. Clinical signs include conjunctival and corneal involvement -which may leave scarring opacities-and in the most severe stage, limbal insufficiency with definitive corneal conjunctivalization.

There is no consensus on the therapeutic strategy to adopt. Treatment is based on a combination of antihistamines and mast cell stabilizers, and in case of failure on corticosteroids. Cortico-resistant or cortico-dependent forms require treatment with local or general immunosuppressants, because of the long-term ocular complications of corticosteroids. These local immunosuppressants, belonging to the class of calcineurin inhibitors, have been used in ophthalmology for many years in hospital preparations of ciclosporin eye drops. More recently, commercial forms have appeared on the market: RESTASIS® (0.05% cyclosporine eye drops), IKERVIS® and VERKAZIA® (0.1% cyclosporine eye drops), CICLOGRAFT® (2% cyclosporine eye drops) and TALYMUS® (0.1% tacrolimus eye drops).

Although TALYMUS® has French marketing authorization for VKC, its place in the therapeutic strategy and its positioning in relation to the various cyclosporine eye drops is not clearly established. Series have reported similar efficacy of TALYMUS® and 0.05% and 2% cyclosporine in patients with KCV, at a lower dosage than those usually required for cyclosporine eye drops (2 drops per day for TALYMUS® versus 3 to 4 drops per day for cyclosporine). Given the difficulties of compliance in children, particularly in a school environment and in the context of a chronic pathology, the possibility of a less frequent administration represents a significant advantage. The simplicity of use and efficacy of TALYMUS® , as well as its safety profile, which is comparable to that of cyclosporine eye drops, have led some authors to recommend it as a first-line eye drop on a par with cyclosporine.

In addition, in numerous publications and in our experience, there are cases of failure of treatment with cyclosporine eye drops, which have even led some authors to recommend for many years only hospital preparations of cyclosporine at concentrations greater than or equal to 1%. It is therefore to be expected that cases of resistance to VERKAZIA® will appear.

One study reported the efficacy of a 0.1% tacrolimus hospital preparation in patients who had failed 1% cyclosporine therapy. However, the efficacy of TALYMUS® treatment in patients who have failed ciclosporin 2% therapy has not been reported to date.