EYSUVIS Eye Drops for Dry Eye by Kala Pharmaceuticals - DOES IT WORK?
There is an exciting new medication on the market for dry eye sufferers, and it specifically targets acute flare-ups of the condition. Kala Pharmaceuticals has completed their Phase 3 clinical trial, the Short Term Relief of Dry Eye (STRIDE 3) and the medication is now available with a prescription. In this Phase 3 trial, their KPI-121 0.25% loteprednol etabonate ophthalmic suspension was evaluated on safety and effectiveness before hitting the market in early 2021.
This suspension is marketed under the brand name Eysuvis, and it is a low dose topical steroid intended for short term use in the treatment of dry eye disease. It is to be used by patients for no more than two weeks. Those who suffer from this condition know how frustrating it can be, with symptoms often flaring up unexpectedly. Eysuvis is potentially a great treatment for those flare-ups.
Eysuvis Side Effects
During Phase 2 and 3 clinical trials, this medication was evaluated in randomized fashion. The two main safety variables the study looked at include adverse events and intraocular pressure (IOP). Topical ophthalmic steroids, and corticosteroids in general, are known to increase IOP in some individuals (known as steroid responders). Although the risk is low, this does place the individual at a higher risk of developing glaucoma. Any increase in baseline IOP ≥ 5mmHg which raises the eye pressure ≥21mmHg was considered an IOP elevation in this trial. Less than 0.6% of participants had this pressure increase.
The most common side effect noted is instillation site pain, meaning that the eyes likely burned when the drops were put in. This is a very common side effect of ocular steroids to begin with, so it’s not surprising that this finding was there.
Contraindications for the use of Eysuvis include those similar to other topical steroids and are as follows:
Viral diseases of the cornea and/or conjunctiva - Epithelial herpes simplex (dendritic keratitis) and herpes zoster (varicella)
Bacterial infections of the eye, such as corneal ulcers
Fungal infections of the eye
We can expect the cost of this medication to be high for most people. Traditionally, new dry eye medications hitting the market come in between $300-500 without insurance, and newer topical steroids are not much lower than that. According to GoodRx, Eysuvis currently costs between $450-500 without insurance. It is likely that some healthcare insurance plans will eventually cover this medication in part, but doctors will have to use their clinical judgement when deciding to prescribe what’s likely to be an expensive medication. As with anything, the benefits must outweigh the harm of not using the medication.
Currently, a few alternatives exist for this medication but none of them are specifically approved for the treatment of dry eye disease. For example, there are many other topical ophthalmic corticosteroids on the market that could be used in the same fashion, although none of them are at the same loteprednol concentration as Eysuvis (they’re either higher or lower). Because these alternatives exist and will likely be more affordable, it will be interesting to see what optometrists and ophthalmologists decide to prescribe.
Our Thoughts on Eysuvis
Anything new to help those with dry eye disease is a good thing. It means there is more research going into this condition and eventually there will be more public awareness as well. We do love that it is directly indicated for dry eye disease, and we believe it will be very helpful for those who have flare-ups of their condition every once in a while. This medication is also only used for two weeks, so the risk of long term side effects (such as IOP elevation) is very low.
I’d like to point out the ingredients in this medication, while we’re on the topic of effectiveness and safety for the patient:
ACTIVE: loteprednol etabonate 2.5 mg (0.25%)
INACTIVES: glycerin, sodium citrate dihydrate, sodium chloride, Poloxamer 407, edetate disodium dihydrate, citric acid, and water for injection.
PRESERVATIVE: benzalkonium chloride 0.01% (BAK)
I don’t love that it contains BAK, as this common preservative has been shown to cause corneal toxicity in some individuals. This isn’t a deal breaker, but we usually recommend that our patients avoid ocular preservatives if they can. However, if you’ve got incredibly uncomfortable eyes and nothing else is working to calm them, it’s likely that this medication will be a great choice.
As always, make sure to discuss all treatment plans with your eye doctor, and visit them if you ever notice a flare-up or worsening of your condition.