Xiidra® (lifitegrast ophthalmic solution 5%) became FDA approved in mid-July 2016 and has been widely successful since its release. However, this is still considered a new medication that’s still finding its way into the pharmaceutical marketplace. Some things have yet to be determined, but sharing what is known is important for the millions of people who could benefit from this medication.
During FDA trials, Xiidra was found to start working in test subjects as early as two weeks after the beginning of the application and most felt a positive difference in their dry eyes within 12 weeks. The efficacy and safety of this medication was studied in four well-controlled trials over a period of 12 weeks, and over 2100 patients were studied. Improved symptom relief was noted in two of the four studies at two, six, and 12 weeks.
Also at 12 weeks, Xiidra was shown to improve the signs of dry eyes, measured by inferior corneal staining. This is a huge jump forward from Restasis (cyclosporine ophthalmic emulsion 0.05%), which typically takes about six months before a real difference is felt by users or seen by your eye doctor. We’ll go into a bit more about Restasis vs. Xiidra later in the article.
Xiidra is FDA approved to treat the signs and symptoms of dry eye disease, or keratoconjunctivitis sicca, as we discussed above. We know this can get a little confusing, but it basically works by inhibiting the binding of inflammatory cells.
This mechanism decreases inflammation mediated by T lymphocytes (a type of white blood cell that plays a critical role in your body’s immunity), therefore improving dry eye signs and symptoms. More specifically, Xiidra blocks the interaction of ICAM-1 and LFA-1, which are key players of the inflammation behind dry eye. Although we know all of this, the exact mechanism of action is still unknown.
Xiidra comes in a preservative-free solution in eye drop form and is dispensed in small, single-use vials as a 30-day supply. It is prescribed as one drop in each eye, twice per day, morning and evening. If you cannot take the medication in the morning and evening, it is important to still make sure that your doses are 12 hours apart. Each vial should be discarded after one single use, as there are no preservatives in the solution to prevent contamination should the vial be left out and open.
Although some may be concerned about systemic absorption, this risk was shown to be very low. If you’re concerned, make sure to use the eye drops and then apply pressure to the inside corners of your eyes (where your punta drain), as this may prevent even more systemic absorption.
Keep in mind, the FDA trials tested only a few thousand subjects, so further side effects could be found as the drops hit the market and are used more comprehensively for dry eye patients. But the side effects determined by the trial are noted to be the following:
It is important to note that, if your eyes are inflamed (as most are with dry eye disease), anything you put into your eyes has the potential to sting or burn. Xiidra is no different, and it is very common for the medication to burn for a few seconds to minutes after instillation. This side effect, although very common, is harmless and will subside as your eyes heal.
According to GoodRx, Xiidra is going to cost you over $500 without insurance or coupons. Of course, even if you do have an insurance plan, everyone’s insurance is different. We know that many will cover some of the cost of Xiidra, which is a huge help for the millions of Americans that need it. It’s estimated that about 30% of Medicare plans will cover this medication, so you’ll be left with a small copay. Even better, if you’re eligible, you can use a coupon through Xiidra’s website to get your first month free and only pay $10 per month after that. Make sure to check that out here.
Their website also includes savings such as $20 for a 90-day supply, so if you don’t qualify for one deal, you might just qualify for another. Either way, there are ways to save despite the large chunk of change they demand for self-pay patients.
Xiidra is so new that there is no generic for this medication. However, there are loads of alternative ways to treat your dry eyes. Let’s start simple, and we’ll build from there (make sure to ask yourself if you’re doing all of these...and if you’re not...get to it!):
Now that we’ve gone through some of the things you can do to treat your dry eyes besides using Xiidra and other pharmaceuticals, let’s dive into whether or not Xiidra actually does what it says it does. Does it work?
Well, in clinical studies over a 12 week period, Xiidra was shown to reduce dry eye symptoms in as little as two weeks (some patients took longer than others, but most noticed improvement within 12 weeks). Now, this is data from the makers of Xiidra, so we also looked outside.
According to Everyday Health, Xiidra worked well for many people and we read tons of reviews from patients who were very satisfied with the relief they found. Actually, the majority of bad reviews came down to expectations. Nearly all of these bad reviews mentioned side effects that are known to occur with Xiidra, but their doctors likely neglected to warm them about.
Complaints regarding burning and stinging and blurred vision were prevalent, and some complaints of headaches and a metallic taste were noted as well. So, we take this with a grain of salt. If you’ve got the right expectations for any treatment, and the right mindset going into it, you’re likely to be more successful than someone who expects the worst and thinks nothing will ever work for them.
Now onto this important distinction and one of the main questions we are asked when discussing either of these medications. Which is better? Well, one main difference between Restasis, a decade-old medication used to treat dry eye, and Xiidra, is that Xiidra is approved to treat not just dry eye signs but its symptoms as well. That distinction is because of the nature of the product.
Xiidra stops a chemical chain reaction in the cells. When the drop hits the eye, the drop binds with proteins in the cells that stop the signals that would otherwise create many of the problems and symptoms of dry eye including itching, burning, pain, and redness. This effect can be noticed quite quickly!
Restasis, on the other hand, is a slower process. Although the exact mechanism of action is also unknown, we do know that it contains a topical immunomodulator with anti-inflammatory effects. Over time, this medication helps the eyes produce more of their own high quality tears which, in turn, helps the patient feel relief.
The important thing to note with both of these medications is that they are not artificial tears. They’re not designed to give you immediate relief because they’re healing your eyes from the inside out, not simply putting a bandaid on the problem. Healing takes time.
Xiidra is a wonderful new prescription medication that is available from your eye doctor. If you’ve truly tried all of our alternative treatment options and are still struggling with dry eyes, it might be a great option for you!
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