Safety and efficacy of loteprednol etabonate ophthalmic ointment 0.5% for the treatment of inflammation and pain following cataract surgery

Timothy L Comstock, Michael R Paterno, Angele Singh, Tara Erb, Elizabeth Davis, Timothy L Comstock, Michael R Paterno, Angele Singh, Tara Erb, Elizabeth Davis

Abstract

Background: To compare the safety and efficacy of loteprednol etabonate ophthalmic ointment 0.5% (LE ointment), a new topical ointment formulation, with vehicle for the treatment of inflammation and pain following cataract surgery.

Methods: Two randomized, multicenter, double-masked, parallel-group, vehicle-controlled studies were conducted. Patients aged ≥18 years with a combined postoperative anterior chamber cells and flare (ACI) ≥ Grade 3 following uncomplicated cataract surgery participated in seven study visits. Patients self-administered either topical LE ointment or vehicle four times daily for 14 days. Efficacy outcomes included the proportion of patients with complete resolution of ACI and the proportion of patients with no (Grade 0) pain at postoperative day 8. Safety outcomes included the incidence of adverse events, ocular symptoms, changes in intraocular pressure and visual acuity, and biomicroscopy and funduscopy findings.

Results: Data from the two studies were combined. The integrated intent-to-treat population consisted of 805 patients (mean [standard deviation] age 69.0 [9.2] years; 58.0% female and 89.7% white). Significantly more LE ointment-treated patients than vehicle-treated patients had complete resolution of ACI (27.7% versus 12.5%) and no pain (75.5% versus 43.1%) at day 8 (P < 0.0001 for both). Fewer LE ointment-treated patients required rescue medication (27.7% versus 63.8%), and fewer had an ocular adverse event (47.2% versus 78.0%, P < 0.0001) while on study treatment. The most common ocular adverse events with LE ointment were anterior chamber inflammation, photophobia, corneal edema, conjunctival hyperemia, eye pain, and iritis. Mean intraocular pressure decreased in both treatment groups. Four patients had increased intraocular pressure ≥10 mmHg (three LE ointment and one vehicle) prior to rescue medication. Visual acuity and dilated funduscopy results were similar between the treatment groups, with the exception of visual acuity at visits 5 and 6, which favored LE ointment.

Conclusion: LE ointment was efficacious and well tolerated in the treatment of ocular inflammation and pain following cataract surgery.

Keywords: cataract surgery; intraocular pressure; loteprednol etabonate; ophthalmic ointment; postoperative inflammation; postoperative pain.

Figures

Figure 1
Figure 1
Flow of patients through the study. Abbreviations: AE, adverse event; LE, loteprednol etabonate.
Figure 2
Figure 2
Proportion of patients with rescue medication use prior to each visit. Abbreviation: LE, loteprednol etabonate.
Figure 3
Figure 3
Proportion of patients with complete resolution of anterior chamber inflammation A), complete resolution of anterior chamber cells B), complete resolution of anterior chamber flare C), and no (Grade 0) pain D) at each study visit. Notes: Visit 4 = day 3 (±1 day); visit 5 = day 8 (±1 day); visit 6 = day 15 (±1 day); visit 7 = day 18 (±1 day). *P < 0.0001; †P = 0.0008. Abbreviation: LE, loteprednol etabonate.
Figure 4
Figure 4
Mean (± standard error of the mean) change from baseline in intraocular pressure (mmHg) by visit. Abbreviation: LE, loteprednol etabonate.

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