Comparative study of olopatadine hydrochloride 0.1% and emedastine difumarate 0.05% comparing their clinical efficacy and adverse effects in allergic conjunctivitis

To assess the efficacy and adverse effects of 0.1% Olopatadine hydrochloride [OHC] and compare them to 0.05% Emedastine difumarate [ED] in the treatment of allergic conjunctivitis. Prospective and comparative study. The study was conducted at Islam Teaching Hospital, Islam Medical College, Sialkot from February 2013 to June 2014. 74 adult patients including 35 male patients aged 21- 47 years [Average 32.39] and 39 females aged 20 - 42 years [Average 31.8] some with a history of systemic allergic manifestation [e.g. asthma,dermatitis, or bronchitis] along with sign and symptoms of allergic conjunctivitis were enrolled in the study. At the time of induction, manifestations of allergic conjunctivitis [mucous discharge, itching, conjunctival congestion,chemosis, and watering] were present. Patients were allocate at random to either of the 2 groups, A and B. The patients in the Group A, [n = 36] received OHC and those in the Group B [n = 38] were treated with ED. The dose in Group A was one drop in both the eyes 12 hourly. Group B received one drop in both the eyes 6 hourly. The study was started on the first patient visit, when after the diagnosis; the drug was administered. Patients from both the groups were re-evaluated half an hour, forty eight hours, seven and fourteen days later. Efficacy and side effects in both the groups were assessed. The severity of signs and symptoms were assigned a score from 0 - 3. The results were analysed using independent sample T test. At the start of the study, cumulative score of the patient's sign and symptoms was calculated, with a mean value of 7.31 for group A and 7.38 for group B. There was no significant statistical disparity between the groups [p= 0.88]. The cumulative scores at the end of study on day fourteen were 0.72 for group A and 1.0 for group B. This was also statistically not significant [p = 0.15] but Olopatadine was noted to be more effective. The side effects of both the medicines were similarly assessed with cumulative scores calculated at each follow up. In group A, there were minimal side effects with mean cumulative score on the final visit was 0.25 in group A and0.54 in Group B, with statistically significant [p = 0.015] difference. Olopatadine was discovered to have better efficacy [not statistically significant] and less adverse effects [statistically significant] than Emedastine

A Role of Staphyococcus aureus, Interleukin-18, Nerve Growth Factor and Semaphorin 3A, an Axon Guidance Molecule, in Pathogenesis and Treatment of Atopic Dermatitis

Staphylococcus aureus (SA) is usually present not only in the skin lesions of atopic dermatitis (AD) but also in the atopic dry skin. SA discharges various toxins and enzymes that injure the skin, results in activation of epidermal keratinocytes, which produce and release IL-18. IL-18 that induces the super Th1 cells secreting IFN-gamma and IL-13 is supposed to be involved in development of AD and its pathogenesis. Indeed, the number of SA colonies on the skin surface and the serum IL-18 levels in patients with AD significantly correlated with the skin scores of AD lesions. Also, there is strong positive correlation between the skin scores and serum IL-18 levels in DS-Nh mice (P<0.0001, r=0.64), which develop considerable AD-like legions when they are housed under conventional conditions, but develop skin legions with less severity and less frequency under specific pathogens free (SPF) conditions. Therefore, they are well-known as model mice of AD, in which SA is presumed to be critical factor for the development of AD lesions. Also, theses DS-Nh mice pretreated with Cy developed more remarkable AD-like lesions in comparison with non-treated ones. The levels of INF-r and IL-13 in the supernatants of the lymph node cell cultures stimulated with staphylococcal enterotoxin B (SEB) or ConA were increased in the Cy-treated mice, although the serum levels of total IgE were not. In this experiment, we revealed that Cy-treated mice, to which CD25 +CD4 + reguratory T cells taken from non-treated ones had been transferred, developed the AD-like legions with less severity and less number of SA colonies on the skin surface. Therefore, it is presumed that CD25 +CD4 + reguratory T cells might be involved in the suppression of super Th1 cells which are induced by IL-18 and are involved in the development of AD-like lesions rather than IgE production. The efficient induction of CD25 +CD4 + reguratory T cells is expected for the new type of treatment of AD. We also found that farnesol (F) and xylitol (X) synergistically inhibited biofilm formation by SA, and indeed the ratio of SA in total bacteria at sites to which the FX cream containing F and X had been applied was significantly decreased 1 week later, accompanied with improvement of AD, when compared with that before application and at placebo sites. Therefore, the FX cream is a useful skin-care agent for atopic dry skin colonized by SA. The nerve growth factor (NGF) in the horny layer (the horn NGF) of skin lesions on the cubital fossa was collected by tape stripping and measured using ELISA in AD patients before and after 2 and 4 weeks treatments. Simultaneously, the itch and eruptions on the whole body and on the lesions, in which the horn NGF was measured, were recorded, and also the peripheral blood eosinophil count, serum LDH level and serum total IgE level were examined. The level of NGF was significantly higher in AD patients than in healthy controls, correlated with the severity of itch, erythema, scale/xerosis, the eosinophil count and LDH level, and also significantly decreased after treatments with olopatadine and/or steroid ointment for 2 and 4 weeks. Therefore, the measurement of the NGF by this harmless method seems to be useful to assess the severity of AD and the therapeutic effects on AD. In AD patients, C-fiber in the epidermis increase and sprout, inducing hypersensitivity, which is considered to aggravate the disease. Semaphorin 3A (Sema3A), an axon guidance molecule, is a potent inhibitor of neurite outgrowth of sensory neurons. We administered recombinant Sema3A intracutaneously into the skin lesions of NC/Nga mice, an animal model of AD, and investigated the effect of Sema3A on the skin lesions and their itch. Sema3A dose-dependently improved skin lesions and attenuated the scratching behavior in NC/Nga mice. Histological examinations revealed a decrease in the epidermal thickness, the density of invasive nerve fibers in the epidermis, inflammatory infiltrate including mast cells and CD4 +T cells, and the production of IL-4 in the Sema3A-treated lesions. Because the interruption of the itch-scratch cycle likely contributes to the improvement of the AD-like lesions, Sema3A is expected to become a promising treatment of patients with refractory AD.

Comparação entre o uso tópico do fumarato de cetotifeno 0.025 por cento e do cloridrato de olopatadina 0.1 por cento no tratamento da ceratoconjuntivite primaveril / Comparative study between 0.025 percent ketotifen fumarate and 0.1 percent olopatadine hydrochloride in the treatment of vernal keratoconjunctivitis

OBJETIVO: O objetivo desse estudo foi comparar as soluções oftálmicas de fumarato de cetotifeno 0,025 por cento e de cloridrato de olopatadina 0,1 por cento em pacientes portadores de ceratoconjuntivite primaveril. MÉTODOS: Avaliação realizada em um único centro, simples-cega, comparando-se paralelamente cetotifeno e olopatadina. As medicações foram avaliadas em 4 momentos (dias 1, 7, 14 e 21) por meio de tabelas de graduações padronizadas. A freqüência de eventos adversos foi a principal variável de segurança. RESULTADOS: Na avaliação da evolução do prurido ocular, ardor, lacrimejamento, hiperemia conjuntival, secreção e fotofobia observou-se que o uso tópico do cetotifeno proporcionou melhora significante deste sintoma em relação a olopatadina (p>0,05). Observou-se que a partir do 7° dia de tratamento os pacientes em uso da olopatadina tinham menos ardor, em relação aos que fizeram uso do cetotifeno, mas após o 21° dia essa relação inverteu. Na comparação da sensação de corpo estranho, papilas e pontos de Horner-Trantas evidenciou-se equivalência sem significância estatística. CONCLUSÃO: Concluímos que ambas são drogas equivalentes e atuaram de forma eficaz e segura na remissão dos sintomas relacionados à conjuntivite alérgica primaveril. Houve diferença a favor do cetotifeno (p<0,05) na melhora do prurido, lacrimejamento, hiperemia conjuntival, presença de secreção e fotofobia.

PURPOSE: To compare the topical use of 0.025 percent ketotifen fumarate and 0.1 percent olopatadine hydrochloride in the treatment of patients with vernal keratoconjunctivitis. METHODS: A study performed in one center, simple masked, parallel-group compared ketotifen and olopatadine. These patients were evaluated on four visits during the treatment (days 1, 7, 14 and 21), defined by ratings scores. Adverse events were the main variable of safety rating. RESULTS: On evaluating ocular itching, burning, tearing, conjunctival hyperemia, mucous discharge and photophobia, the ketotifen group showed a significant improvement of total signs and symptoms (p<0.05). Between the baseline and the 2nd visit, treatment with olopatadine resulted in decreased burning, but after the 4th visit, ketotifen was slightly better. Sand sensation, papillae and Horner-Trantas dots were not significantly different in both groups. CONCLUSION: Both drugs were efficient and safe relieving the main symptoms and signs of vernal keratoconjunctivitis. Between the same timepoints, there was a significant difference in favor of ketotifen-treated patients (p<0.05), showing improvement of itching, tearing, conjunctival hyperemia, mucous discharge and photophobia.

Comparaçäo do uso tópico de cetotifeno com a olopatadina no tratamento de conjuntivites alérgicas / Comparison between topical use of ketotifen and olopatadine in the treatment of allergic conjunctivitis

Objetivo: Avaliar e comparar a eficácia e tolerância do uso tópico do fumarato de cetotifeno a 0,05 por cento e cloridrato de olopatadina a 0,1 por cento no tratamento de pacientes com conjuntivite alérgica. Método: Foi realizado estudo clínico mascarado, randomizado comparando a eficácia, segurança e os efeitos colaterais com o uso da soluçäo oftálmica de fumarato de cetotifeno a 0,05 por cento e cloridrato de olopatadina a 0,1 por cento no alívio dos sintomas e sinais em pacientes com conjuntivite alérgica. Trinta e quatro pacientes obedecendo aos critérios de inclusäo do protocolo receberam um frasco com a droga mascarada e instilaram uma gota duas vezes por dia em cada olho durante 30 dias. Os sintomas e sinais dos pacientes foram avaliados em uma visita pré-tratamento e cinco com tratamento (1º dia, 2º dia, 7º dia, 14º dia e 30º dia). Resultados: A gravidade da conjuntivite alérgica foi semelhante nos dois grupos do estudo. Tanto cetotifeno como a olopatadina foram equivalentes e eficazes na diminuiçäo dos sintomas de prurido, ardor e lacrimejamento. Quanto aos sinais, a hiperemia em conjuntiva bulbar foi atenuada nos dois grupos. Na avaliaçäo das reaçöes adversas observou-se ardor após a administraçäo de ambos colírios e a ocorrência de prurido no grupo do cetotifeno. Näo foi observada nenhuma reaçäo de hipersensibilidade das drogas estudadas. Conclusöes: Este estudo evidencia que a soluçäo oftálmica de fumarato de cetotifeno a 0,05 por cento e o cloridrato de olopatadina a 0,1 por cento quando instilados duas vezes ao dia durante 30 dias, säo eficazes e seguros no alívio dos principais sintomas das conjuntivites alérgicas.