PRAGUE – Tacrolimus 0.03% ointment has earned first-line, treatment-of-choice status in atopic blepharoconjunctivitis, the most common ocular complication of atopic dermatitis, Dr. Ville Kiiski said at the annual congress of the European Academy of Dermatology and Venereology.
In a 10-year, single-center review of 338 patients on long-term topical therapy for atopic blepharoconjunctivitis with either tacrolimus (Protopic), pimecrolimus 1% cream (Elidel), or topical corticosteroids, tacrolimus displayed the best efficacy and tolerability, according to Dr. Kiiski of Helsinki University Central Hospital.
Tacrolimus ointment was the primary therapy in 297 patients as young as 2 years old. Thirty-three patients were on pimecrolimus, while just eight patients were treated mainly with topical steroids. Most Finnish physicians are reluctant to prescribe topical steroids for long-term use in the eyelid area because of the well-known associated increased risks of cataracts, elevated intraocular pressure, and skin atrophy, the dermatologist noted.
The mean follow-up was 1.5 years for treatment efficacy and 5.8 years for malignancy risk.
The treatment discontinuation rate because of intolerance of side effects was 33% with pimecrolimus and 9.1% for tacrolimus. Twenty-two percent of patients placed on pimecrolimus discontinued the drug because of insufficient efficacy, compared with 1.6% on tacrolimus.
The blepharitis response rate was 90% in tacrolimus-treated patients, 79% with pimecrolimus, and 88% in the handful of patients on topical steroids. The conjunctivitis response rates were 80%, 55%, and 50% with tacrolimus, pimecrolimus, and topical steroids, respectively.
Tacrolimus-treated patients were an adjusted 2.37-fold more likely to experience significant improvement in their blepharitis than patients on pimecrolimus and 2.34-fold more likely to see improvement in their conjunctivitis.
Intraocular pressure dropped over time by a mean of 0.6 mm Hg in patients on either of the topical calcineurin inhibitors. None of the three topical therapies was associated with adverse effects on vision, lens, or cornea, nor were there adverse trends in terms of bacterial infections or malignancies.
Atopic blepharoconjunctivitis occurs when inflammatory disease activity at the eyelid margins traumatizes the ocular surface, aggravating keratitis and conjunctivitis.
The study was free of commercial sponsorship or investigator financial conflicts.