Recently, Cequa (cyclosporine ophthalmic solution 0.09%) became only the third dry eye medication to be approved by the FDA in the past 19 years. This is exciting for those of us suffering from dry eyes, as well as for those who treat it.
FDA approved to treat dry eye disease by enhancing tear production, it works as an immunomodulator in a similar fashion to its earlier competitor. Like the Restasis that we know all too well, Cequa uses cyclosporine but in a much higher concentration. This higher concentration is also part of a formula that includes nanomicelles. Micelles are gelatinous congregates of hydrophilic and hydrophobic molecules that can help with absorption of a substance. Sun Pharma (the manufacturer of Cequa) says these will help increase the ability of Cequa to penetrate the ocular tissues and overcome any solubility changes.
For the patient, this means a more effective medication, because penetration into the cells of the cornea and conjunctiva will be enhanced. Hopefully, this also means the medication will work more quickly, since it is well known that Restasis can sometimes take six months for the patient to notice changes in their dry eye symptoms.
Cequa was evaluated in two randomized studies with over 1000 patients suffering from dry eye disease. Compared to control at day 84, use of Cequa for 12 weeks showed a statistically significant increase in tear production (measured by Schirmer Score). Corneal and conjunctival staining was evaluated earlier, and positive changes were noted as early as four weeks.
As of October 2019, Cequa is now available from Sun Ophthalmics in the US. Cequa is dosed just like Restasis and Xiidra twice per day, 12 hours apart, morning and evening. The new medication comes in single-use vials that should be discarded immediately after each use. Each box contains six pouches with 10 vials each, for a one month supply.
Cequa should never be used while wearing contact lenses, and the company advises that dry eye patients should likely not be wearing extended wear contact lenses anyway. If contact lenses are worn, they may be inserted 15 minutes after instillation of the medication.Â
Since Cequa is such a new medication, information regarding cost and savings will begin to roll out. Currently, many patients with commercial insurance are able to get Cequa for as low as $5 for a 1-month supply and as low as $10 for a 3-month supply through their savings program. Of course, this varies by insurance and you may be asked to pay up to $90 for 1 month and $180 for 3 months. These savings do exclude Medicare and Medicaid plans.
We will continue to update this blog as more information comes available but, without insurance, you are looking at about $500 per month.