Factors Affecting Compliance With 0.05% Cyclosporine Emulsion in Patients With Dry Eye Syndrome

Seong Kyu Im; Kyung Chul Yoon

doi:10.3341/jkos.2010.51.7.921

Journal List > J Korean Ophthalmol Soc > v.51(7) > 1008854

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Im and Yoon: Factors Affecting Compliance With 0.05% Cyclosporine Emulsion in Patients With Dry Eye Syndrome

Original Article

J Korean Ophthalmol Soc 2010;51(7):921-926.

Published online: 31 August 2010

DOI: https://doi.org/10.3341/jkos.2010.51.7.921

Factors Affecting Compliance With 0.05% Cyclosporine Emulsion in Patients With Dry Eye Syndrome

Seong Kyu Im, MD, Kyung Chul Yoon, MD, PhD

Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, Korea

Address reprint requests to Kyung-Chul Yoon, MD, PhD, Department of Ophthalmology, Chonnam National University Hospital #8 Hak-dong, Dong-gu, GwangJu 501-757, Korea Tel: 82-62-220-6742, Fax: 82-62-227-1642, E-mail: kcyoon@jnu.ac.kr

Received 27 July 2009 Accepted 18 May 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the factors affecting compliance with the use of 0.05% cyclosporine emulsion in patients with dry eye syndrome.

Methods

A total of 148 patients using 0.05% cyclosporine emulsion for dry eye were divided into two groups (compliant vs. non-compliant). The compliant group included the patients who used 0.05% cyclosporine emulsion more than 50% of frequency as they had been prescribed. We analyzed factors affecting compliance, including age, gender, severity of symptoms, side effects, use of topical steroid, socioeconomic status, associated systemic disease, number of eyedrops, visit interval, and detailed instruction about 0.05% cyclosporine emulsion.

Results

The compliant group included 124 patients (83.8%), and the non-compliant group included 24 patients (16.2%). Multivariate analysis showed that the factors associated with low compliance were severe symptoms, longer visit interval, side effects, lower socioeconomic status, and poor detailed instruction (P＜0.05). In contrast, gender, associated systemic disease, and number of eyedrops did not affect the compliance for use of 0.05% cyclosporine emulsion.

Conclusions

Special attention should be given to patients with the above risk factors to improve compliance with the use of 0.05% cyclosporine emulsion.

Keywords: Compliance, Cyclosporine emulsion, Dry eye syndrome, Factors

References

1. The definition and classification of dry eye disease: report of the definition and classification subcommittee of the International Dry Eye Workshop (2007). Ocul Surf. 2007; 5:75–92.

2. Sall K, Stevenson OD, Mundorf TK, Reis BL. Two multicenter, randomized studies of the efficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease. Ophthalmology. 2000; 107:631–9.

3. Stevenson D, Tauber J, Reis BL. Efficacy and safety of cyclosporine A ophthalmic emulsion in the treatment of moderate- to-severe dry eye disease: a dose-ranging, randomized trial. Cyclosporine A Phase 2 Study Group. Ophthalmology. 2000; 107:967–74.

4. Perry HD, Donnenfeld ED. Topical 0.05% cyclosporine A in the treatment of dry eye. Expert Opin Phamacother. 2004; 5:2099–107.

5. Trattler W, Katsev D, Kerney D. Self-reported compliance with topical cyclosporine emulsion 0.05% and onset of the effects of increased tear production as assessed through patient surveys. Clin Ther. 2006; 28:1848–56.

6. Chiang TH, Walt JG, McMahon JP Jr. Real-world utilization pat-terns of cyclosporine ophthalmic emulsion 0.05% within managed care. Can J Clin Pharmacol. 2007; 14:240–5.

7. Lam H, Bleiden L, De Paiva CS, et al. Tear cytokine profiles in dysfunctional tear syndrome. Am J Ophthalmol. 2009; 147:198–205.

8. Chen JJ, Rao K, Pflugfelder SC. Corneal epithelial opacity in dysfunctional tear syndrome. Am J Ophthalmol. 2009; 148:376–82.

9. Krishnaiah S, Vilas K, Shamanna BR, et al. Smoking and its association with cataract: results of the Andhra Pradesh eye study from India. Invest Ophthalmol Vis Sci. 2005; 46:58–65.

10. Nussenblatt RB, Palestine AG. Cyclosporin: immunology, phar-macology and therapeutic use. Surv Ophthalmol. 1986; 31:159–69.

11. Hoffmann F, Wiederholt M. Local treatment of corneal trans-plants in the human with cyclosporin A. Klin Monatsbl Augenheikd. 1985; 187:92–6.

12. Kiliç A, Gürler B. Topical 2% cyclosporine A in preservative free artificial tears for the treatment of vernal keratoconjunctivitis. Can J Ophthalmol. 2006; 41:693–8.

13. Perry HD, Doshi-Carnevale S, Donnenfeld ED, et al. Efficacy of commercially available topical cyclosporine A 0.05% in the treatment of meibomian gland dysfunction. Cornea. 2006; 25:171–5.

14. Kunert KS, Tisdale AS, Gipson IK. Goblet cell numbers and epithelial proliferation in the conjunctiva of patients with dry eye syndrome treated with cyclosporine. Arch Ophthalmol. 2002; 120:330–7.

15. Stevenson D, Tauber J, Reis BL. Efficacy and safety of cyclosporine A ophthalmic emulsion in the treatment of moderate- to-severe dry eye disease: a dose-ranging, randomized trial. Cyclosporine A Phase 2 Study Group. Ophthalmology. 2000; 107:967–74.

16. Brignole F, Pisella PJ, De Saint Jean M, et al. Flow cytometric analysis of inflammatory markers in KCS: 6-month treatment with topical cyclosporine A. Invest Ophthalmol Vis Sci. 2001; 42:90–5.

17. Turner K, Pflugfelder SC, Ji Z, et al. Interleukin-6 levels in the conjunctival epithelium of patients with dry eye disease treated with cyclosporine ophthalmic emulsion. Cornea. 2000; 19:492–6.

18. Kunert KS, Tisdale AS, Stern ME, et al. Analysis of topical cyclosporine treatment of patients with dry eye syndrome: effect on conjunctival lymphocytes. Arch Ophthalmol. 2000; 118:1489–96.

19. Holland EJ, Olsen TW, Ketcham JM, et al. Topical cyclosporin A in the treatment of anterior segment inflammatory disease. Cornea. 1993; 12:413–9.

20. Barber LD, Pflugfelder SC, Tauber J, Foulks GN. Phase Ⅲ safety evaluation of cyclosporine 0.1% ophthalmic emulsion administered twice daily to dry eye disease patients for up to 3 years. Am J Ophthalmol. 2005; 112:1790–4.

21. Patel SC, Spaeth GL. Compliance in patients prescribed eyedrops for glaucoma. Ophthalmic Surg. 1995; 26:233–6.

22. MacKean JM, Elkington AR. Compliance with treatment of patients with chronic open angle glaucoma. Br J Ophthalmol. 1983; 67:46–9.

23. Konstas AG, Maskaleris G, Gratsonidis S, Sardelli C. Compliance and viewpoint of glaucoma patients in Greece. Eye. 2000; 14:752–6.

24. Ahn DH, Lee YG, Hong YJ. Factors affecting compliance with prescribed eyedrops for glaucoma. J Korean Ophthalmol Soc. 1998; 39:2145–51.

Table 1.

Demographics of patients using 0.05% cyclosporine emulsion

	Compliant group	Non-compliant group
Number of patients	124	24
Male/Female (number of patients (%))	34 (27%) / 90 (73%)	10 (42%) / 14 (58%)
Mean age (years)	44.7±12.0	47.1±15.3
Mean follow-up period (months)	11.3±2.3	11.8±3.1

Table 2.

Analysis of factors affecting compliance with use of 0.05% cyclosporine emulsion in patients with dry eye

	Variable	Number of patients (%)		P value
	Variable	Compliant	Non-compliant	P value
Gender	Male Female	34 (77.3) 90 (86.5)	10 (22.7) 14 (13.5)	0.16
Diagnosis	Sjogren, GVH^*, SJS^† Non-Sjogren-DES^‡	44 (84.6) 80 (83.3)	8 (15.4) 16 (16.7)	0.84
Symptom severity	Mild Moderate to severe	78 (86.7) 46 (79.3)	12 (13.3) 12 (20.7)	<0.01
Visit interval	<1 month >1 month	64 (90.1) 60 (77.9)	7 (9.9) 17 (22.1)	0.04
Number of topical ophthalmic solutions	≤3 ≥4	60 (78.9) 64 (88.9)	16 (21.1) 8 (11.1)	0.14
Side effects	Yes No	49 (72.1) 75 (93.8)	19 (27.9) 5 (6.3)	<0.01
Topical steroid	Use No use	84 (80.8) 40 (90.9)	20 (19.2) 4 (9.1)	0.13
Socioeconomic state	Middle to upper Lower	92 (88.5) 32 (72.7)	12 (11.5) 12 (16.2)	0.02
Detail explanation	Yes No	78 (90.7) 48 (77.4)	8 (9.3) 14 (22.6)	0.01

^* GVH=graft versus host disease

^† SJS=Stevens-Johnson syndrome

^‡ DES=dry eye syndrome.

Table 3.

Factors affecting compliance with use of 0.05% cyclosporine emulsion in patients with dry eye syndrome: univariate analyses

	Variable	Odds ratio	95% CI^*	P value
Age	≤50 ≥51	1 2.08	0.98-5.01	0.11
Gender	Female Male	1 1.89	0.77-4.66	0.17
Diagnosis	NonSjogren-DES^† Sjogren, GVH^‡, SJS^§	11.10	0.44-2.77	0.84
Symptom severity	Mild Moderate to severe	1 1.70	0.70-4.09	0.24
Visit interval	<1 month >1 month	1 2.59	1.00-6.69	0.05
Number of topical opht solutions	thalmic ≥4≤3	12.13	0.85-5.35	0.11
Side effects	No Yes	1 5.816	2.04-16.60	<0.01
Topical steroid	No use Use	12.38	0.76-7.43	0.14
Socioeconomic state	Middle to upper Lower	1 2.88	1.17-7.04	0.02
Detail explanation	Yes No	12.99	1.18-7.69	0.02

^* CI=confidence interval

^† DES=dry eye syndrome

^‡ GVH=graft versus host disease

^§ SJS=Stevens-Johnson syndrome.

Table 4.

Factors affecting compliance with use of 0.05% cyclosporine emulsion in patients with dry eye syndrome: multivariate analyses^*

Variable	Odds ratio	95% CI^†	P value
Symptom severity (moderate to severe)	3.45	1.02 – 11.64	0.04
Visit interval (>1 month)	5.87	1.40 – 24.62	0.02
Side effects (yes)	5.38	1.58 – 16.67	0.01
Socioeconomic state (lower)	4.03	1.15 – 14.13	0.03
Detail explanation (poor)	4.62	1.21 – 12.04	0.01

^* Only variables with P<0.05 are shown.

^† CI=confidence interval.

TOOLS

Similar articles