Comparison of Bromfenac vs. Ketorolac During the Induction Phase of Treatment with Topical Cyclosporine for Dry Eye Patients Barry A. Schechter, MD Florida Eye Microsurgical Institute Boynton Beach, Florida, USA

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Comparison of Bromfenac vs. Ketorolac During the
Induction Phase of Treatment with Topical
Cyclosporine for Dry Eye Patients Barry A.
Schechter, MDFlorida Eye Microsurgical
InstituteBoynton Beach, Florida, USA
Consultant for Ista Pharmaceuticals Consultant
for Allergan Pharmaceuticals
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Purpose and Methods

• PURPOSE
• Some dry eye patients have discomfort when first
  initiating cyclosporine therapy. NSAIDs have been
  shown to be helpful in reducing this discomfort
• ( Schechter J of Ophthalmic Pharmacology
  Therapeutics 2006 April 22 (2)150-4)
• We compared the efficacy of ketorolac 0.4 vs.
  bromfenac 0.09 each when used concomitantly with
  cyclosporine A for improvement of patient comfort
  during the induction phase of cyclosporine
  therapy for dry eye.
• METHODS
• Randomized, prospective, single-site study
• Patients received either bromfenac 0.09 (n22)
  or ketorolac (n21) 10 minutes prior to
  administering topical cyclosporine twice daily
• Study visits were at Baseline (Visit 1), Week 2
  (Visit 2), and Week 6 (Visit 3)

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Patient Demographics

• Mean age of the patients was 60.2 11.7 years in
  the bromfenac group and 61.4 14.5 years in the
  ketorolac group (P.779)
• 31 of the 43 patients were female (72)

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Greater Improvement in Schirmers Scores with
Bromfenac cyclosporine
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Greater Improvement in TBUT with Bromfenac
cyclosporine
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Greater Reduction in Staining with Bromfenac
cyclosporine
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Greater Improvement in OSDI Scores with Bromfenac
cyclosporine
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Patients Reported Greater Comfort with Bromfenac
cyclosporine

• At Visit 3, patients were asked to rate whether
  their drop regimen had been comfortable or
  painful and to rate the severity on a scale of 0
  to 3 (where 0none and 3very painful).
• In the bromfenac group, 17/22 patients reported
  that the drops were comfortable or not at all
  painful.
• Conversely, in the ketorolac group, only 5/21
  patients reported that the drops were comfortable
  or not at all painful.
• These differences were statistically significant
  (Plt.001).
• In the bromfenac group, only 2/22 (9.1) of
  patients reported that they had been experiencing
  at least mild pain
• Conversely, in the ketorolac group, more than
  half (12/21, 57.1) reported that they had been
  experiencing at least mild pain.
• These differences were statistically significant
  (Plt.001).
• No other adverse events were reported.

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Discussion

• Changes from baseline in Schirmers scores, tear
  break-up time, ocular surface staining, and OSDI
  scores were improved in both groups of patients.
  The scores, however, were significantly better
  with bromfenac than with ketorolac at both
  follow-up visits (Plt.008).
• More bromfenac patients than ketorolac patients
  found the drops comfortable (77 vs. 24, Plt.001)
  and bromfenac patients were less likely than
  ketorolac patients to report experiencing
  discomfort (9.1 vs. 57.1, Plt.001).

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Conclusion

• In this study, bromfenac cyclosporine was
  better tolerated than ketorolac cyclosporine
  during treatment induction for dry eye.
• All dry eye measurements (OSDI,TBUT and Schirmers
  scores) were better in the bromfenaccyclosporine
  group than the ketorolaccyclosporine group.