What are the indications, age range, and initial management requirements for Verkazia (cyclosporine)?

From the Guidelines

Verkazia (cyclosporine ophthalmic emulsion 0.1%) is indicated for the treatment of severe vernal keratoconjunctivitis (VKC) in children and adolescents from 4 to 17 years of age, as well as for adults with DROSD-related severe, dry eye disease that has not improved despite treatment with ocular lubricants, as stated in the marketing authorization 1.

Key Points to Consider

• No specific initial management is required before starting Verkazia, though a comprehensive eye examination and confirmation of VKC or DROSD diagnosis should be performed by an ophthalmologist.
• According to the expert consensus, ocular topical ciclosporin can be offered to children and young people (4–17 years) with severe, DROSD-related vernal keratoconjunctivitis that has not improved despite treatment with standard topical therapy 1.
• For adults with DROSD-related severe, dry eye disease, ocular topical ciclosporin can be offered if the condition has not improved despite treatment with ocular lubricants, in line with its marketing authorization 1.

Administration and Side Effects

• Verkazia is typically administered as one drop in each affected eye four times daily during the VKC season, and treatment can be continued as needed.
• Patients should be instructed to wash their hands before application, shake the vial well before use, and avoid wearing contact lenses during treatment.
• Common side effects include eye pain and eye pruritus.
• If patients are using multiple eye medications, they should be advised to space applications at least 15 minutes apart, with Verkazia being the last medication applied.

Important Considerations

• Ongoing, regular supervision by an ophthalmologist is recommended for those on longer-term (> 8 weeks) corticosteroid eyedrop therapy for people with DROSD where corticosteroid-sparing agents are ineffective or contraindicated, and dupilumab withdrawal is not advisable 1.
• A combination of tacrolimus ointment and ciclosporin drops can be considered for people with treatment-resistant DROSD 1.

From the Research

Verkazia Medication Indication and Age Range

• Verkazia, also known as cyclosporine, is indicated for the treatment of vernal keratoconjunctivitis (VKC) 2, 3, 4, 5, 6.
• The age range of patients treated with Verkazia in the studies varied, with a mean age of 8.31 +/- 2.79 years in one study 3 and a range of 5 to 19 years in another study 4.
• In one study, patients as young as 5 years old were treated with topical cyclosporine 4.

Initial Management Required Before Starting Verkazia

• There is no clear indication that any specific initial management is required before starting Verkazia 2, 3, 4, 5, 6.
• However, some patients may require additional treatment with topical corticosteroids during exacerbations 3, 6.
• In one study, 55% of treated patients required the additional use of a 3-day course of topical dexamethasone with 1.13 ± 0.81 mean courses/month 6.

Safety and Efficacy of Verkazia

• Verkazia has been shown to be safe and effective for the treatment of VKC in several studies 2, 3, 4, 5, 6.
• The most common side effect reported was a mild burning sensation and tearing after administration of cyclosporine 2, 3.
• No significant changes were recorded in terms of kidney and liver enzymatic activities and also in terms of cyclosporine serum levels in one study 3.