Restasis benefits with anti-inflammatory medicine

[Ariel]

http://www.agingeye.net/mainnews/newscan2.php

It is stated here that "increased tear production was not seen in patients currently taking topical anti-inflammatory drugs"

Is this accurate?

I'm starting to use compounded cyclosporine and I want to make sure I don't combine its use with any drug that can interfere with its performance.

[spmcc]

Re: Restasis commercial

Someone I know saw this commercial a few days ago in the States and told me about it : http://www.restasis.com/video/video.htm

It does say that "[Restasis] did not increase tear production in patients using topical steroid drops or tear duct plugs".

Wow!

[indrep]

The 26th page of www.fdarestasisdata.org shows which groups the FDA used to approve Restasis. Its the two groups that HAD punctal plugs inserted. This approval came on the fifth submission. Keep in mind, the target for approval was increased tear production above 10mm using schirmer strips.

[Ariel]

Good question Chemia.

I'm guessing cyclosporine's tear production won't be affected by the use of "Acular" eye drops (ketorolac trometamol) which is a non-steroidal anti-inflammatory drug (NSAID).

[indrep]

Chemia,
The steroids knock down the inflammation immediately. It is also thought to reduce the stinging many patients experience with Restasis.

The plugs are inserted to keep as much water on the ocular surface to provide comfort, reduce the osmolarity of the tear (eliminating the environment that causes inflammation.) and provide clearer vision.

I am going with that the doctor isn't wrong, he hasn't been properly informed.

[Ariel]

Indrep,

I just found that "Acular" eye drops which are an (NSAID) can have many serious side effects and steroids that bring immediate relief, on top of being more dangerous, should only be taken for a few days so what unti-inflammatory medicine is safe enough to warrant its use on a daily basis over long periods?

[jenny2008]

so if you began restasis and had plugs put in immediately does that mean that restasis won't work?? i am more confused than ever....every doctor i have been to had recommended i keep my plugs and stay on restasis.. would i show more improvement in tears without plugs???

[indrep]

Jenny,
Restasis (cyclosporine) acts as anti-inflammatory on the lacrimal ducts. It does not actually increase the making/manufacturing of tears. By reducing the inflammation of the lacrimal DUCT ( the part of the lacrimal gland that allows the tears out of the gland) theoretically more tears will make it to your ocular surface.

If nothing is done to eliminate the inflammatory environment of the ocular surface you would need to be on restasis forever for whatever benefit you currently have.

[jenny2008]

thank you for your explanation. i really appreciate it.. From the way things are stated on this site it made me think that since i had punctal plugs put in the same time i began Restasis ( over 3 years ago) that the Restasis would not work because of the plugs. I am still confused as to why people are stating that Restasis will not decrease inflammation if you have punctal plugs and/or on steriod drops?? can you please explain?? thanks!!!

[indrep]

www.fdarestasisdata.org

This website shows the FDA submission (fifth one) that received approval. I think its about page 26 where you will read that the two groups that showed significant improvement were the two groups of "cyclosporin and punctal plugs".

One important item to remember is the "end point" for success was described as "Schirmer's strip score of 10 or greater". Unfortunately most patients have lost some of their ability to manufacture tears as we age, so in order to keep enough tears on the ocular surface we need help. Punctal occlusion does this.

As to why the company does not make this known is up to them. $550 million plus in annual revenue is hard to give up. I would assume that if doctors knew you needed plugs for this product to work they would use more plugs and less Restasis.

Restasis does work for some people and that should not be forgotten. It is just not the "end all solution" that it has been promoted to be. Ocular surface issues are quite complex after only a few months of the "cause". As with most complex diseases the treatment will be a combination of meds, therapies, lifestyle changes, etc. and will need to be continued for differing periods of time.

[jenny2008]

Wow.. You really cleared things up for me.. sounds like i am on the right track with my doctor..thanks so much for your indepth response!! i very much appreciate it!