Predicting the future is nearly impossible to do with accuracy. But, when the future is now, the world opens up at your feet. For years, doctors had few choices when it came to ophthalmic prescription drug therapy for dry eye disease (DED). Cyclosporine A, autologous serum, and off-label use of drugs such as steroids were the mainstay. Although some patients thrived with these treatments, others begged for more options. For years, practitioners sat with baited breath and watched one potential drug after another fail to make it through the rigors of FDA studies.
In July 2016, Xiidra (Lifitegrast 5%, Shire) was approved by the FDA for DED. It was first drug to do so in more than a decade and the only drug with the indication to treat both the signs and symptoms of dry eye. Four robust studies were completed, with more than 2,000 patients enrolled and treated. Impressively, some patients felt improvement within 2 weeks of initiating therapy. Whether driven by published data or eternal optimism, doctors have met Xiidra with enthusiasm.
The role of inflammation in DED has been well established. Xiidra brings a new drug class to treat the chronic and likely progressive inflammation experienced by patients and to potentially provide earlier symptomatic improvement. Physicians are often puzzled and frustrated by the subjective-objective mismatch presented by patients with DED. Xiidra’s indication gives a new tool that can be utilized in either circumstance.
As practitioners gain more experience with the drug, Xiidra may show other clinical advantages. Surgical patients may benefit from prophylactic treatment prior to cataract and refractive surgery. Contact lens wearers may prolong satisfaction and wear time with its use. Tech junkies may be able to stay on their digital devices longer and with decreased discomfort. Much remains to be seen, but doctors are optimistic that Xiidra will be a game changer for dry eye patients and will lead the way for more innovations in the pipeline.