Patients undergoing hematopoietic stem cell transplantation for cancers such as leukemia and lymphoma are at a high risk of graft-versus-host disease (GVHD). And the most common ocular manifestation of GVHD is dry eye disease (DED)—a condition for which clinical management remains problematic despite ongoing research.
But does DED associated with GVHD pose a particularly difficult treatment challenge? A team at the Massachusetts Eye and Ear Infirmary confirmed that it does—and they found evidence suggesting that topical steroids and artificial tears may be of limited benefit.1
Study specifics. In this single-center study, the researchers compared the efficacy of a low-dose topical steroid for treating patients who have moderate-to-severe DED associated with GVHD versus patients with DED from other causes. Over the course of 4 weeks, both groups received 0.5% loteprednol. For non-GVHD patients, the treatment decreased average Ocular Surface Disease Index scores by 34% and average corneal fluorescein staining scores by 41%. Treatment with artificial tears also decreased those 2 scores by 22% and 32%, respectively. The same treatments, however, had a minimal effect in patients with GVHD.
Why it matters. The clinical manifestation of DED associated with GVHD is often very similar to cases of DED associated with other causes. However, as Jia Yin, MD, PhD, pointed out, treatment protocols should differ. “Our own clinical experience has shown that moderate-to-severe DED associated with GVHD is more challenging to manage and might require alternative therapeutics. And we now have scientific evidence to back that up.”
Need for new treatments. Dr. Yin noted that very few rigorous clinical studies have focused on patients with DED and GVHD, despite the fact that DED is recognized as a major ocular morbidity in this population. Thus, her team hopes that these results will help others look beyond currently available treatment regimens and develop new options.
“Our study confirms the impression of many ophthalmologists caring for GVHD patients that their significant DED is very difficult to treat. We also conclusively demonstrate the limitation of a commonly used short-term topical steroid for treating moderate-to-severe DED in these patients. These findings warrant both a more in-depth understanding of the DED mechanisms in GVHD and a quest for more effective treatments,” she said.
1 Yin J et al. Am J Ophthalmol. 2018;190:17-23.
Relevant financial disclosures—Dr. Yin: None.
For full disclosures and the disclosure key, see below.
Full Financial Disclosures
Dr. Chang Carl Zeiss: C; Eyenovia: O; Iantech: C,O; Icon Bioscience: O; iDrops: C,O; Ivantis: C,O; Johnson & Johnson Vision: C; Mynosys: O,C; PowerVision: C,O; Presbyopia Therapies: O; RxSight: O,C; Slack: P; Versant Ventures: O.
Dr. Holekamp Alimera Sciences: C,L,S; Allergan: C,L,S; BioTime: C; Genentech: C,L,S; Katalyst: C,P; NotalVision: S; Novartis: C; Ophthotech: S; Ohr Pharmaceutical: S; Regeneron: C,L.
Dr. Shantha Santen: C.
Dr. Yeh Alcon: S; Clearside Biomedical: C; Santen: C.
Dr. Yin None.
||Consultant fee, paid advisory boards, or fees for attending a meeting.
||Employed by a commercial company.
||Lecture fees or honoraria, travel fees or reimbursements when speaking at the invitation of a commercial company.
||Equity ownership/stock options in publicly or privately traded firms, excluding mutual funds.
||Patents and/or royalties for intellectual property.
||Grant support or other financial support to the investigator from all sources, including research support from government agencies (e.g., NIH), foundations, device manufacturers, and/or pharmaceutical companies.
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