Ciclosporin A Plus Hydrocortisone Tend to Benefit Sjögren’s Dry Eye in Small Study

Marisa Wexler MS avatar

by Marisa Wexler MS |

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Combining the anti-inflammatory medicines hydrocortisone and ciclosporin A could help ease eye symptoms in people with Sjögren’s syndrome, according to a new study.

The study, “Efficacy of Topical Hydrocortisone in Combination with Topical Ciclosporin A for the Treatment of Dry Eye Disease in Patients with Sjögren Syndrome,” was published in the Journal of Ophthalmology.

Sjögren’s syndrome is an autoimmune disease in which the body’s immune system attacks tissue in the tear and salivary glands. Dry eyes are one of the most common symptoms of Sjögren’s.

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To effectively manage dry eyes in people with Sjögren’s, lubricating eyedrops that contain an anti-inflammatory agent are often necessary. Hydrocortisone is a powerful anti-inflammatory steroid medication that tends to cause fewer side effects than other steroid medicines. However, steroids should not be used long term because they can cause serious side effects with prolonged use.

Ciclosporin A is another anti-inflammatory medicine that is commonly used in eyedrops for Sjögren’s, but there is often a lag of a week or two between the start of ciclosporin A treatment and the noticeable easing of symptoms. As such, patients sometimes are also given drops of hydrocortisone early in treatment to get more immediate symptom relief.

Here, a trio of scientists in Austria conducted a study to examine the short- and long-term effects of this kind of combined treatment. The study enrolled 12 participants, two male and 10 female; their mean age was 62.3 years. Three had primary Sjögren’s, the rest had secondary disease, and all had severe dry eyes.

Throughout the six-month study, all eyes of all the participants were treated with ciclosporin A (0.1%) eyedrops, administered once daily in the evening. In the first two weeks of treatment, hydrocortisone (0.335%) drops were applied three times daily, to only one eye in each patient. The patients were also given lubricating eyedrops (without anti-inflammatory medicines) for routine daily use.

The scientists compared outcomes for the eyes given the combination and those given ciclosporin A alone. For both groups, patient-reported symptom severity decreased markedly after starting treatment, but the decreases tended to be more pronounced in the combination group.

Both groups showed reductions over baseline (the study’s start) in tear breakup time, which is basically a measure of how quickly the eyes dry out after blinking. This reduction was statistically significant in the combination group, but not in the group that took ciclosporin A alone. Direct comparisons between the two groups showed no significant difference.

Other measures of dry-eye symptoms generally showed consistent results, with the combination group doing either as well or better than the group taking ciclosporin A alone. The combination group also tended to perform better in terms of visual acuity after six months.

“Our data indicate that if short-term hydrocortisone can safely be combined with long-term ciclosporin A therapy, it could provide the fast improvement of clinical symptoms and may have positive long-term effects on the optical image quality,” the researchers concluded.

The team noted that this study was limited by its small sample size, which likely contributed to the lack of significant differences seen between groups, since a smaller study has less statistical power to detect such differences.