Inès Roumeau1, Adrien Coutu1, Valentin Navel2, Bruno Pereira3, Julien S Baker4, Frédéric Chiambaretta5, Dominique Bremond-Gignac6, Frédéric Dutheil7. 1. Ophthalmology, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France. 2. Ophthalmology, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France; Translational Approach to Epithelial Injury and Repair, CNRS, INSERM, GReD, Université Clermont Auvergne, Clermont-Ferrand, France. Electronic address: vnavel@chu-clermontferrand.fr. 3. Biostatistics unit, University Hospital of Clermont-Ferrand, Clinical Research and Innovation Direction, Clermont-Ferrand, France. 4. Hong Kong Baptist University, Centre for Health and Exercice Science Ressearch, Physical Education and Health, Kowlon Tong, Hong Kong. 5. Ophthalmology, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France; Translational Approach to Epithelial Injury and Repair, CNRS, INSERM, GReD, Université Clermont Auvergne, Clermont-Ferrand, France. 6. Ophthalmology, University Hospital Necker Enfants Malades, Paris, France; Sorbonne Paris Cité University, INSERM, UMRS1138, Team 17, From physiopathology of ocular diseases to clinical development, Cordeliers search centre, Paris, France. 7. Physiological and Psychosocial Stress, LaPSCo, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France. Preventive and Occupational Medicine, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Witty Fit, Clermont-Ferrand, France; Australian Catholic University, Faculty of Health, School of Exercise Science, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: Vernal keratoconjunctivitis (VKC) is a severe type of allergic conjunctivitis for which treatment strategies are still under debate. OBJECTIVE: To conduct a systematic review and meta-analysis to evaluate the efficacy of medical treatments for VKC. METHODS: The PubMed, Cochrane Library, Embase, and ScienceDirect databases were searched to assess the efficacy of treatments for VKC. We computed random-effect meta-analyses on changes in clinical scores of symptoms and signs between baseline and after treatment, stratified on treatment classes. Meta-regressions searched for potential influencing parameters. RESULTS: We included 45 studies (27 randomized controlled trials and 18 prospective cohort studies): 1749 patients (78% men, mean age 11.2 years) and 12 different treatment classes. Mast cell stabilizers (usually considered as first-line therapy), cyclosporine, and tacrolimus were the most studied drugs (3/4 of studies). Overall, all clinical scores improved. Total symptom and sign score decreased for mast cell stabilizers (MCS, effect size -3.19, 95CI -4.26 to -2.13), cyclosporine (-2.06, -2.72 to -1.40), and tacrolimus (-2.39, -3.36 to -1.43). No significant differences were shown depending on treatment classes, concentration, age, gender, baseline activity scores, and atopy. Sensitivity analyses demonstrated similar results. CONCLUSION: We confirm the efficacy of MCS in the treatment of VKC. Efficacy of cyclosporine and tacrolimus did not differ, promoting that tacrolimus is a good alternative to cyclosporine for severe cases of VKC. Further studies are needed to compare other drugs and precise their place in treatment strategy.
BACKGROUND:Vernal keratoconjunctivitis (VKC) is a severe type of allergic conjunctivitis for which treatment strategies are still under debate. OBJECTIVE: To conduct a systematic review and meta-analysis to evaluate the efficacy of medical treatments for VKC. METHODS: The PubMed, Cochrane Library, Embase, and ScienceDirect databases were searched to assess the efficacy of treatments for VKC. We computed random-effect meta-analyses on changes in clinical scores of symptoms and signs between baseline and after treatment, stratified on treatment classes. Meta-regressions searched for potential influencing parameters. RESULTS: We included 45 studies (27 randomized controlled trials and 18 prospective cohort studies): 1749 patients (78% men, mean age 11.2 years) and 12 different treatment classes. Mast cell stabilizers (usually considered as first-line therapy), cyclosporine, and tacrolimus were the most studied drugs (3/4 of studies). Overall, all clinical scores improved. Total symptom and sign score decreased for mast cell stabilizers (MCS, effect size -3.19, 95CI -4.26 to -2.13), cyclosporine (-2.06, -2.72 to -1.40), and tacrolimus (-2.39, -3.36 to -1.43). No significant differences were shown depending on treatment classes, concentration, age, gender, baseline activity scores, and atopy. Sensitivity analyses demonstrated similar results. CONCLUSION: We confirm the efficacy of MCS in the treatment of VKC. Efficacy of cyclosporine and tacrolimus did not differ, promoting that tacrolimus is a good alternative to cyclosporine for severe cases of VKC. Further studies are needed to compare other drugs and precise their place in treatment strategy.