Dr. Cremers’ Experience with Xiidra
As of today, I have prescribed Xiidra on at least 100 patients. I have had 12 come back thus far. Only 1 so far has said that Xiidra did not help at all. I do know that this patient has Sjogrens Syndrome and Stage 3 on Meibomian Gland Loss on LipiView.
The rest of the patients have been plesantly surprised: so have I!
I do not stop Restasis before starting Xiidra if they have been doing well on Restasis with no complaints as Restasis and Xiidra work on two separated pathways of imflammation. Of the 12 patients that have come back thus far, 4 were also on Restasis and felt and improvement with Xiidra.
I will be keeping track to see how our patients are doing on this drug.
What is Xiidra?
Xiidra is Lifitegrast which is a new T-cell integrin antagonist that is designed to mimic the binding epitope of ICAM-1. It serves as a molecular decoy to block the binding of LFA-1/ICAM-1 and inhibits the downstream inflammatory process. In vitro studies have demonstrated that lifitegrast inhibits T-cell adhesion to ICAM-1-expressing cells and inhibits secretion of pro-inflammatory cytokines including interferon gamma, tumor necrosis factor alpha, macrophage inflammatory protein 1 alpha, interleukin (IL)-1α, IL-1β, IL-2, IL-4, and IL-6, all of which are known to be associated with DED. Lifitegrast has been FDA approved for the treatment for the symptoms and signs of Dry Eye Disease.
Restasis is only FDA approved for the signs of Dry Eye Disease.
Restasis vs Xiidra: 4 big differences
Until July 11, 2016, Restasis was the only topical eyedrop approved by the FDA to treat patients with dry eye which was approved 13 years ago. More than 30 million Americans suffer from dry eye symptoms of some sort.
In the last 13 years we have learned that Dry Eye, Dry Eye Syndrome, and Dry Eye Disease (which are essential stagees of the same underlying beast) if largely due to an inflammatory condition affecting all the layers of the eye that produce the tear: the Lacrimal Gland, the Goblet Cells that produce Mucin, and the Meibomian Glands that produce oil.
Especially in patients with rheumatoid arthritis and Sjogren’s syndrome, if the dry eye is left untreated, the inflammation will worse and I have found such disease to decimate the Meibomian Glands, likely from a cycle of inflammation that affects all cells of the eye’s surface and glands. If left untreated, the symptoms and signs of the dry eye will worsen over time.
We know understand why artificial tears, punctual plugs and warm compresses may not be enough to help those who suffer from dry eye.
1. Xiidra Works Faster than Restasis. Restasis can take up to 16 weeks to see a difference. Xiidra was able to show improvements within 2 to 12 weeks of treatment. Most of my 12 patients that have returned that found it helpful said it improved their symptoms within 2-3 weeks. Xiidra works affects the T-cells earlier in its binding and in the inflammatory cycle than Restasis, so it makes sense to me that patients would respond sooner.
2. Xiidra is approved by the FDA to treat both the signs and symptoms of dry eye. . Why is this important? The reason it’s been 13 years since any drop was approved for dry eye is because dry eye notoriously complex to study. The signs don’t always match the symptoms and showing improvements in both was basically a statistical nightmare. Restasis could not show improvement in both, but Xiidra did after conducting one of the largest studies of its kind, looking at over 2500 eyes.
3. Xiidra Stings Less than Restasis. 6 of my 12 patients did not notice stinging. All 4 patients on Restasis also said Xiidra stings less than Restasis. All eye surgeons have patients who stopped Restasis because of the terrible pain. Often we had to give a low dose steroid like Lotemax, so Restasis could be tolerable. For some patients, the burning from Restasis never got better and they had to stop completely even though studies showed inflammatory scores would be better for them 3 years down the line. Xiidra caused less stinging and burning and does not require additional medications for tolerability.
4. Xiidra can Taste Worse than Restasis: Punctal Occulusion helps prevent this mild side effect. Non of my patients complained about it as I taught every one how to apply punctal occulsion.
5. Xiidra costs about $500 per month which is about the same as Restasis out of pocket. For now Xiidra is giving away free samples so I would jump on this if I had dry eye.
Sandra Lora Cremers, MD, FACS
I have no stock in this company.