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Aqueous tacrolimus solution in canine KCS
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Keratoconjunctivitis sicca (KCS) is a common problem in certain dog breeds. Years ago the only effective therapy was the subconjunctival injection of corticosteroids followed by topical steroids combined with artificial tears, and the discovery of cyclosporin A offered a very important and effective alternative in the therapy of this chronic eye problems. How effective is tacrolimus, which acts similar to cyclosporin A and is used a lot now in canine medicine?
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One hundred five dogs diagnosed with KCS [Schirmer tear test (STT) 10 mm/min and clinical signs of dry eye] were included in this study. Eyes with marginally decreased STT (11 15 mm/min) and clinical signs of dry eye were also evaluated.
The investigation was conducted in two parts: an initial efficacy study and a subsequent double blinded controlled study.
In the efficacy study, the effect of topical tacrolimus (formerly FK-506) on tear production in dogs with primary KCS was evaluated.
Dogs were divided into four categories: 1) 59 eyes (38 dogs) naïve to tear stimulation therapy with initial STT 10 mm/min; 2) 28 eyes (21 dogs) naïve to tear stimulation therapy with initial STT 11 15 mm/min; 3) 30 eyes (15 dogs) maintained successfully on CsA therapy; 4) 47 eyes (24 dogs) unresponsive to CsA therapy.
STT and clinical signs were evaluated prior to and after 6 to 8 weeks of twice daily tacrolimus administration.
Tacrolimus was substituted for CsA therapy in categories 3 and 4.
The controlled study compared the effect of topical tacrolimus in aqueous suspension to administration of the aqueous carrier alone on tear production in 20 dogs with primary KCS.
Results: In the efficacy study, STT increased by 5 mm/min in 84.7%, 25.0%, 26.7% and 51.1% of eyes in categories 1, 2, 3 and 4 respectively after tacrolimus administration.
Eighty-three percent of eyes with extremely low initial STT ( 2 mm/min), increased 5 mm/min after tacrolimus. In the controlled study, STT increased by 5 mm/min in 7/10 dogs (14/20 eyes) that received tacrolimus and in none of the 10 dogs that received aqueous carrier alone.
Dogs receiving just the aqueous carrier were subsequently treated with tacrolimus, and STT increased 5 mm/min in 9 dogs (18/20 eyes) after administration.
Conclusions: Twice daily administration of 0.02% tacrolimus in aqueous suspension effectively increased tear production in dogs with KCS.
Topical tacrolimus is a promising alternative to topical CsA for treatment of KCS and may be beneficial in patients with less than optimal response to topical CsA.
Source: Berdoulay, Andrew, English, Robert V. & Nadelstein, Brad (2005): Effect of topical 0.02% tacrolimus aqueous suspension on tear production in dogs with keratoconjunctivitis sicca. In: Veterinary Ophthalmology 8 (4), 225-232.
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