Tacrolimus use in paediatric VKC

Topical tacrolimus safe and effective for paediatric keratoconjunctivitis

Dermot McGrath

Posted: Tuesday, October 2, 2018

Topical tacrolimus ointment appears to provide a safe and effective treatment for vernal keratoconjunctivitis (VKC) in paediatric patients, according to a study presented by a Spanish team of researchers.
“Tacrolimus 0.03% ointment was effective at reducing signs and symptoms of VKC with few adverse events. It is a good treatment option to reduce the use of long-term topical steroids in VKC,” the study authors concluded in their poster study presented at the World Ophthalmology Congress in Barcelona.
VKC is a sight-threatening inflammatory disease of conjunctiva and cornea and is frequently observed in young children with the onset usually occurring in the first decade of life, according to co-authors José Espinosa Saldaña MD, FEBO, Rocío Rodríquez MD, Laura Soldevila MD and Alba González MD of the Catalonia Retinal Institute in Barcelona.
While its name suggests a seasonal occurrence, the allergic condition frequently persists throughout the year and usually increases in intensity in warmer weather. Clinical signs to look for include the presence of giant papillae on the upper tarsal conjunctiva, the presence of aggregates of epithelial cells and eosinophils at the limbus and marked conjunctival hyperaemia. In severe cases, corneal ulcer may occur both from the onset of the disease and the physical trauma caused by intense eye rubbing.
While topical corticosteroids are often required for controlling symptoms and signs in severe VKC, their use can lead to serious ocular complications. Tacrolimus, which is widely used for the treatment of atopic dermatitis, is a strong, non-steroidal immune suppressant that is up to 100 times more potent than cyclosporine.
The retrospective observational study from January 2014 to January 2017 included 35 children with VKC with a mean age of eight years who were treated with tacrolimus 0.03% ointment every 12 hours. Symptoms such as itching, photophobia and red eyes were monitored before and after the application of tacrolimus ointment.
The mean treatment duration with tacrolimus was 3.5 months, with a maximum of 12 months. Of the study participants 88.5% were medicated with other treatment before the use of tacrolimus, with a majority (83%) receiving a topical steroid. Five patients suspended the treatment due to itching and irritation.
Significant improvements in clinical signs and symptoms were achieved in a majority of patients. A total of 21 patients were able to taper or suspend the use of antihistamines or steroids. The mean score for signs and symptoms before and after treatment with tacrolimus was 1.4 and 7.9 respectively.
Further randomised controlled studies are required to evaluate the appropriate concentration and dosage of topical tacrolimus, as well as the long-term safety profile of this medication, the investigators conclude.

José Espinosa Saldaña: