Back to basics
Dry eye therapeutics is an ever-evolving area which is full of innovation; new products and modalities are constantly being brought to market, addressing aspects of the disease that were previously untreatable. For doctors, this can mean having to determine what, out of an ever-expanding list of products, to prescribe for your patients. However, in the same way that a house needs a solid foundation, if a treatment regimen doesn’t first tackle the core issue that is underpinning the disease, everything else will fall flat.
“I can’t remember the last exam in which I gave a patient a status summary of their primary issues, and inflammation wasn’t number one,” says Crystal Brimer, OD, FAAO. “There may be secondary issues at play, but when we’re discussing them and their treatment, I explain to patients that we first need to get the inflammation under control. Because without doing that, any other treatments won’t last or find long-term success. I think that might be where some doctors get tripped up; they're going straight for the secondary issues and ignoring what's driving them.”
More than the active ingredient
As a proven modality for treating inflammation, many eyecare providers consider cyclosporine a foundational treatment step before looking towards all of the other choices out there. However, there are lots of options within the category of cyclosporine products too. And although it can be tempting to assume that, because they all contain cyclosporine, they’ll all do the same thing, in the same way, and with the same level of efficacy, that’s not necessarily the case.
“No product is just its active ingredient,” says Michael Garanzini. “Nobody is getting pure cyclosporine; they're receiving it within the context of a vehicle that a company has chosen, tested, and manufactured.” And the vehicle in question can hugely affect everything, including what the drug can do, how quickly it acts, and how tolerable it is to patients.
The vehicle can even dictate whether the cyclosporine even has the opportunity to reach its target tissues to effectively treat inflammation at all—as a hydrophobic molecule, cyclosporine does not easily solubilize, making its delivery into the eye difficult. Sun Pharma has navigated this challenge with CEQUA, the first and only cyclosporine treatment to use NCELL® Technology. NCELL encapsulates the cyclosporine in a protective hydrophilic shell, which enables it to pass through the tear film where it is dispensed directly onto the ocular surface.1 From there it can penetrate the ocular tissues to have its intended effect of treating inflammation.
And it works. “We've seen differences with our product versus others—in 14 days we're starting to clear the cornea;2 we're quelling symptoms within 28 days,3 ” Mr. Garanzini explains.
Seeing the difference
However, reducing inflammation is only part of the story. As Dr. Brimer says, “Compliance is everything. You could have the best treatment in the world, but if patients aren’t compliant, they’re not getting the outcome.”
In clinical trials, more than 95% of patients reported CEQUA to be comfortable right from the start, with this comfort lasting throughout the trial period. Additionally, both studies and surveys assessing patients who have used CEQUA, including the study where patients were switched to CEQUA from cyclosporine 0.05%, demonstrated marked improvements in inflammation symptoms in as little as four weeks.4 And by the end of each assessment period, the majority[OB1] of patients stated their preference towards CEQUA over the product they were on before.3 “Both patients and the data shows it's a very tolerable drug that they stay on for a long time,” Mr. Garanzini explains.
Dr. Brimer’s experience with CEQUA in her practice echoes this. “Not all cyclosporine products are the same; it’s not even close,” she says. “For me, the compliance speaks for itself. When my patients start CEQUA, they tend to stick with it year after year; I've got patients who are happy, having been on it since it first came to market. And seeing those results as a practitioner makes me confident and happy.”
Getting the results to patients
“At the end of the day, this is all academic if people can't get the drug,” says Mr. Garanzini. This is why Sun has worked to make sure that there are coverage options for all patients. “We have availability at Cigna, Optum, The Blues, and more. There are a number of large plans that now cover CEQUA.”
However, they also know that sometimes issues can arise, which is why they’ve taken a number of innovative steps to ensure that patients are still able to receive CEQUA when they need it—such as their partnership with PhilRx. “As our partner, PhilRx works with offices to complete the Prior Authorization paperwork, and we see very high rates of approval through the first pass,” Mr. Garanzini explains. “But if that doesn't work, we have a program in which we buy-down the script and provide 60 vials for $89.”
“Whether a patient is commercial or Medicare, we have options to get CEQUA—and its outcomes—to them.”
