What is the availability and use of Lifitegrast (cyclosporine) drops in India for dry eye disease?

Lifitegrast 5% Ophthalmic Solution Availability in India

Lifitegrast 5% ophthalmic solution is available in India and has demonstrated superior efficacy compared to carboxymethylcellulose 0.5% in Indian patients with dry eye disease. 1

Availability and Clinical Use in India

• Lifitegrast 5% (brand name Xiidra) has been studied in randomized, controlled trials specifically in Indian populations, confirming its availability in the Indian market 1
• A recent randomized, double-blind, active-controlled trial conducted in India demonstrated that lifitegrast 5% was more effective than carboxymethylcellulose 0.5% for treating dry eye disease in Indian patients 1
• The medication is administered as twice-daily doses of a single drop in each eye, as established in Indian clinical practice 1

Mechanism of Action and Efficacy

• Lifitegrast is a T-cell integrin antagonist that blocks the interaction between lymphocyte function-associated antigen-1 (LFA-1) and intercellular adhesion molecule-1 (ICAM-1), reducing inflammation in dry eye disease 2, 3
• In Indian patients, lifitegrast 5% demonstrated significantly better outcomes than carboxymethylcellulose 0.5% in multiple clinical parameters:
  • Eye dryness score (EDS)
  • Ocular discomfort score (ODS)
  • Ocular Surface Disease Index (OSDI)
  • Tear film break-up time (TFBUT)
  • Schirmer tear test (STT) scores
  • Corneal fluorescein staining (CFS) scores 1

Position in Treatment Algorithm for Dry Eye Disease in India

• Lifitegrast 5% is positioned as a second-line treatment for moderate to severe dry eye disease when first-line treatments (artificial tears) provide inadequate relief 2, 4
• It can be used as an alternative to cyclosporine for patients with signs and symptoms of dry eye disease that are refractory to artificial tears 5, 4
• The American Academy of Ophthalmology guidelines, which are often followed internationally including in India, recommend lifitegrast as a treatment option for patients with inadequate response to artificial tears 2

Clinical Benefits in Indian Patients

• In the Indian study, patients treated with lifitegrast showed improvements as early as 2 weeks after treatment initiation 1
• By week 6 and continuing through week 12, lifitegrast demonstrated statistically significant improvements compared to carboxymethylcellulose in almost all measured parameters 1
• Global improvement and tolerability were reported to be better with lifitegrast than with carboxymethylcellulose in the Indian patient population 1

Safety and Tolerability in Indian Patients

• No serious safety concerns were reported in Indian patients treated with lifitegrast 5% 1
• The medication was well-tolerated in the Indian population, with favorable global tolerability ratings compared to carboxymethylcellulose 1
• Real-world data from North America shows that most patients (92.4% at 6 months and 84.7% at 12 months) remain on lifitegrast treatment, suggesting good long-term tolerability 6

Common Pitfalls and Considerations

• Lifitegrast should not be used as first-line therapy before trying preservative-free artificial tears 4
• When prescribing lifitegrast, it's important to manage patient expectations regarding:
  • Onset of action (improvements may begin at 2 weeks but continue to develop over 12 weeks) 1
  • Potential for mild ocular burning upon instillation 5
• Concurrent treatment of contributing factors such as blepharitis or meibomian gland dysfunction is essential for optimal outcomes 5, 4