Are there alternatives to Xiidra (lifitegrast) for treating keratoconjunctivitis sicca?

From the Guidelines

Xiidra (lifitegrast) is not the only option for treating keratoconjunctivitis sicca, and alternatives such as Restasis (cyclosporine) may be equally or more effective for certain patients. According to a recent study published in 2024 1, cyclosporine has been shown to be effective in treating moderate dry eye, with a statistically significant increase in Schirmer test results compared to vehicle at 6 months. Additionally, a study published in the same year 1 found that autologous serum eye drops made from a patient's own blood serum may provide superior relief for severe cases of dry eye.

Some key points to consider when evaluating alternatives to Xiidra include:

• The mechanism of action: Cyclosporine works by preventing activation and nuclear translocation of cytoplasmic transcription factors that are required for T-cell activation and inflammatory cytokine production, while lifitegrast blocks the interaction between lymphocyte function-associated antigen 1 (LFA-1) and its ligand intracellular adhesion molecule 1 (ICAM-1) 1.
• Efficacy: Both cyclosporine and lifitegrast have been shown to be effective in treating dry eye symptoms, but the efficacy may vary depending on the individual patient and the severity of their condition 1.
• Safety: Cyclosporine has been reported to cause ocular burning in 17% of patients, while lifitegrast has been shown to be safe over 12 months, but long-term effects are unknown 1.

Other options that may be considered for treating keratoconjunctivitis sicca include:

• Over-the-counter preservative-free artificial tears or nighttime lubricating ointments, which can be very effective for managing dry eye symptoms, especially when combined with lifestyle changes like staying hydrated, using a humidifier, and taking regular screen breaks.
• Corticosteroids, which have been reported to decrease ocular irritation symptoms, decrease corneal fluorescein staining, and improve filamentary keratitis, but should be used with caution due to potential side effects 1.
• Autologous serum and autologous plasma rich in growth factors drops, which have been reported to improve ocular irritation symptoms as well as conjunctival and corneal dye staining in patients with Sjögren’s syndrome and GVHD 1.

From the Research

Alternatives to Xiidra (Lifitegrast) for Treating Keratoconjunctivitis Sicca

There are several alternatives to Xiidra (lifitegrast) for treating keratoconjunctivitis sicca, including:

• Cyclosporine formulations (RESTASIS®, VEVYE®, and CEQUA™) 2
• EYSUVIS™ (loteprednol etabonate ophthalmic suspension 0.25%) 2
• MIEBO™ (perfluorohexyloctane ophthalmic solution) 2
• TYRVAYA™ (varenicline solution nasal spray) 2
• Punctal plugs 2
• Medical devices such as Lumenis OptiLight™, TearCare® system, and TearScience™ LipiFlow™ thermal pulsation system for treating meibomian glands dysfunction (MGD) 2

Upcoming Treatments

Several new treatments are being evaluated for dry eye disease, including:

• Cyclosporine formulations TJO-087 and SCAI-001 eye drops 2
• IC 265, OK-101, PL9643, SYL1001 (tivanisiran), SHJ002, OXERVATE® (cenegermin-bkbj ophthalmic solution 0.002%), HBM9036 (tanfanercept ophthalmic solution), OCS-02 (licaminlimab), MIM-D3 (tavilermide ophthalmic solution 5%), AR-15,512, BRM421, reproxalap, and AZR-MD-001 (selenium sulphide ointment 0.5%) 2

Comparison of Treatment Patterns

A real-world, retrospective analysis compared treatment patterns in patients with dry eye disease receiving OTX-101 (cyclosporine ophthalmic solution 0.09%), CsA (cyclosporine ophthalmic emulsion 0.05%), or LFT (lifitegrast ophthalmic solution 5%) 3

• Patients receiving OTX-101 remained on treatment significantly longer and were significantly less likely to discontinue treatment than patients on CsA
• Older patients remained on OTX-101 significantly longer than CsA
• Patients on CsA were 35% more likely to discontinue treatment than patients on OTX-101; OTX-101 and LFT groups had similar discontinuation rates

Safety and Efficacy

Lifitegrast has been shown to be effective in improving symptoms and signs of dry eye disease 4, 5

• However, there have been reports of serious complications, including corneal perforation and evisceration, following treatment with lifitegrast 6