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Adding Methylprednisolone to Cyclosporine in the Treatment of Sjogren's Syndrome: Presented at ARVO By Cameron Johnston FORT LAUDERDALE, FL -- May 8, 2007 -- Adding methylprednisolone to cyclosporine appears to provide benefits for many patients with severe dry eye associated with Sjogren's syndrome, but the benefit is short lived and typically levels off within three months, a study presented here shows. Presently, topical cyclosporine is the gold standard for treating dry eye in patients with Sjogren's syndrome, said Yeo K. Byun, PhD, researcher, Yonsei University Medical College, Seoul, Korea. This study was planned to answer the question of whether there would be any added benefit from using methylprednisolone in addition to cyclosporine, since other steroids do not offer adequate relief for some patients. For their study, Dr. Byun and colleagues enrolled 46 patients with moderate to severe dry eye associated with Sjogren's syndrome and treated 20 patients were treated for three months with either cyclosporine 0.05% (Restasis) alone, and 26 were treated with cyclosporine plus methylprednisolone. Methylprednisolone was applied four times daily the first week, twice daily the second week, and once daily the third week. Itching, burning, foreign body sensation, photophobia, pain and blurring were evaluated on a four-point scale where 0 was no symptoms and 4 was severe symptoms. Onset of action was measured subjectively using tear film break-up time and fluorescein staining of the conjunctiva and cornea, which were measured at one, two and three months. Patients who received cyclosporine alone had symptom severity scores that were significantly lower from baseline within two months and this carried out to three months, while patients who received methylprednisolone on top of the cyclosporine had significantly lower scores within one month. These improvements also carried out to three months. Within three weeks of initiating treatment, 40% of patients who received cyclosporine plus methylprednisolone had significant symptom relief compared with 27% of those who received cyclosporine alone. One third of patients receiving the combination had symptomatic relief within 3 to 5 weeks compared with 53% of those who received cyclosporine alone, thereby demonstrating that while dual therapy resulted in faster relief, patients who received only cyclosporine did catch up within a couple of weeks. Importantly, this study showed that while there was a slight advantage favouring the methylprednisolone combination in terms of test film break-up time, as well as corneal and conjunctival staining, the difference between the two groups was only apparent in the first month. There was no difference at three months. "After three months there were significant improvements in all clinical parameters, but there were no differences between the two groups," Dr. Byun said. On the basis of this study, she said she would not recommend the routine use of methylprednisolone for all patients with this condition, but would limit its use to patients who are severely bothered by dry eye symptoms and for whom it would not be advisable to wait an extra two weeks to achieve the best results. [Presentation title: Efficacy of Combined Treatment of Cyclosporine 0.05% and 1% Methylprednisolone on Dry Eye Patients of Sjogren Syndrome. Poster 401/B603 E-mail this page to a friend or colleague! To print, use this version