Efficacy of medical treatments for vernal keratoconjunctivitis : A systematic review and meta-analysis

Journal article


Roumeau, Inès, Coutu, Adrien, Navel, Valentin, Pereira, Bruno, Baker, Julien S., Chiambaretta, Frédéric, Bremond-Gignac, Dominique and Dutheil, Frédéric. (2021). Efficacy of medical treatments for vernal keratoconjunctivitis : A systematic review and meta-analysis. Journal of Allergy and Clinical Immunology. 148(3), pp. 822-834. https://doi.org/10.1016/j.jaci.2021.03.026
AuthorsRoumeau, Inès, Coutu, Adrien, Navel, Valentin, Pereira, Bruno, Baker, Julien S., Chiambaretta, Frédéric, Bremond-Gignac, Dominique and Dutheil, Frédéric
Abstract

Vernal keratoconjunctivitis (VKC) is a severe type of allergic conjunctivitis for which treatment strategies are still under debate.

Objectives
This study sought 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. Random-effect meta-analyses on changes in clinical scores of symptoms and signs between baseline and after treatment, stratified on treatment classes, were computed. Meta-regressions were searched for potential influencing parameters.

Results
Included were 45 studies (27 randomized controlled trials and 18 prospective cohort studies), 1749 patients (78% were men; mean age, 11.2 years), and 12 different treatment classes. Mast cell stabilizers (MCSs; usually considered as first-line therapy), cyclosporine, and tacrolimus were the most studied drugs (in three-quarters of studies). Overall, all clinical scores improved. Total symptom and sign score decreased for MCSs (effect size, −3.19; 95% CI, –4.26 to −2.13), cyclosporine (effect size, −2.06; 95% CI, −2.72 to −1.40), and tacrolimus (effect size, −2.39; 95% CI, −3.36 to −1.43). No significant differences were shown depending on treatment classes, concentration, age, sex, baseline activity scores, and atopy. Sensitivity analyses demonstrated similar results.

Conclusions
This study confirms the efficacy of MCSs in the treatment of VKC. Efficacy of cyclosporine and tacrolimus did not differ, suggesting that tacrolimus is a good alternative to cyclosporine for severe cases of VKC. Further studies are needed to compare other drugs and their precise place in treatment strategy.

Keywordschronic disease; immunomodulators; topical drugs; atopy; inflammation; pediatrics
Year2021
JournalJournal of Allergy and Clinical Immunology
Journal citation148 (3), pp. 822-834
PublisherElsevier Inc.
ISSN0091-6749
Digital Object Identifier (DOI)https://doi.org/10.1016/j.jaci.2021.03.026
PubMed ID33819510
Scopus EID2-s2.0-8510527948
Research or scholarlyResearch
Page range822-834
Publisher's version
License
All rights reserved
File Access Level
Controlled
Publication dates
Online02 Apr 2021
Publication process dates
Accepted17 Mar 2021
Deposited23 Nov 2021
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Crendal, Edward, Dutheil, Fred, Naughton, Geraldine, McDonald, Tracey and Obert, Philippe. (2014). Increased myocardial dysfunction, dyssynchrony, and epicardial fat across the lifespan in healthy males. BMC Cardiovascular Disorders. 14(95), pp. 1 - 10. https://doi.org/10.1186/1471-2261-14-95
Atherogenic subfractions of lipoproteins in the treatment of metabolic syndrome by physical activity and diet - the RESOLVE trial
Dutheil, Frederic, Walther, Guillame, Chapier, Robert, Mnatzaganian, George, Lesourd, Bruno, Naughton, Geraldine, Verney, Julien, Fogli, Anne, Sapin, Vincent, Duclos, Martine, Vinet, Agnes, Obert, Philippe, Courteix, Daniel and Lac, Gerard. (2014). Atherogenic subfractions of lipoproteins in the treatment of metabolic syndrome by physical activity and diet - the RESOLVE trial. Lipids in Health and Disease. 13(1). https://doi.org/10.1186/1476-511X-13-112
Comparison of the ultra-low-dose Veo algorithm with the gold standard filtered back projection for detecting pulmonary asbestos-related conditions : A clinical observational study
Tekath, Marielle, Dutheil, Frederic, Bellini, Romain, Roche, Antoine, Pereira, Bruno, Naughton, Geraldine, Chamoux, Alain and Michel, Jean-Luc. (2014). Comparison of the ultra-low-dose Veo algorithm with the gold standard filtered back projection for detecting pulmonary asbestos-related conditions : A clinical observational study. BMJ Open. 4(5), pp. 1 - 8. https://doi.org/10.1136/bmjopen-2014-004980
Right ventricle free wall mechanics in metabolic syndrome without type-2 diabetes: Effects of a 3-month lifestyle intervention program
Serrano-Ferrer, Juan, Walther, Guillaume, Crendal, Edward, Vinet, Agnes, Dutheil, Frederic, Naughton, Geraldine A., Lesourd, Bruno, Chapier, Robert, Courteix, Daniel and Obert, Philippe. (2014). Right ventricle free wall mechanics in metabolic syndrome without type-2 diabetes: Effects of a 3-month lifestyle intervention program. Cardiovascular Diabetology. 13(1), pp. 1 - 11. https://doi.org/10.1186/s12933-014-0116-9
Atherogenic subfractions of lipoproteins in the treatment of metabolic syndrome by physical activity and diet : the RESOLVE trial
Dutheil, Frederic, Walther, Guillaume, Chapier, Robert, Mnatzaganian, George, Lesourd, Bruno, Naughton, Geraldine, Verney, Julien, Fogli, Anne, Sapin, Vincent and Duclose, Martine. (2014). Atherogenic subfractions of lipoproteins in the treatment of metabolic syndrome by physical activity and diet : the RESOLVE trial. Lipids in Health and Disease. 13(112), pp. 1 - 9. https://doi.org/10.1186/1476-511X-13-112
Myocardial deformation and twist mechanics in adults with metabolic syndrome : Impact of cumulative metabolic burden
Crendal, Edward, Walther, Guillaume, Vinet, Agnes, Dutheil, Frederic, Naughton, Geraldine, Lesourd, Bruno, Chapier, Robert, Rupp, Thomas, Courteix, Daniel and Obert, Philippe. (2013). Myocardial deformation and twist mechanics in adults with metabolic syndrome : Impact of cumulative metabolic burden. Obesity: a resourch journal. https://doi.org/10.1002/oby.20537
Urinary Interleukin-8 is a biomarker of stress in emergency physicians, especially with advancing age: The JOBSTRESS* randomized trial
Dutheil, Frederic, Trousselard, Marion, Perrier, Christophe, Lac, Gerard, Chamoux, Alain, Duclos, Martine, Naughton, Geraldine, Mnatzaganian, George and Schmidt, Jeannot. (2013). Urinary Interleukin-8 is a biomarker of stress in emergency physicians, especially with advancing age: The JOBSTRESS* randomized trial. PLoS ONE. 8(8), pp. 1 - 7. https://doi.org/10.1371/journal.pone.0071658
Different modalities of exercise to reduce visceral fat mass and cardiovascular risk in metabolic syndrome : the RESOLVE* randomized trial
Dutheil, Frederic, Lac, Gerard, Lesourd, Bruno, Chapier, Robert, Walther, Guillaume, Vinet, Agnes, Sapin, Vincent, Verney, Julien, Ouchchane, Lemlih and Duclos, Martine. (2013). Different modalities of exercise to reduce visceral fat mass and cardiovascular risk in metabolic syndrome : the RESOLVE* randomized trial. International Journal of Cardiology. https://doi.org/10.1016/j.ijcard.2013.05.012
The long-term effects of occupational exposure to vinyl chloride monomer on microcirculation : a cross-sectional study 15 years after retirement
Lopez, Vincent, Chamoux, Alain, Tempier, Marion, Thiel, Helene, Ughetto, Sylvie, Trousselard, Marion, Naughton, Geraldine and Dutheil, Frederic. (2013). The long-term effects of occupational exposure to vinyl chloride monomer on microcirculation : a cross-sectional study 15 years after retirement. BMJ Open. https://doi.org/10.1136/bmjopen-2013-002785
Treatment of Metabolic syndrome by combination of physical activity and diet needs an optimal protein intake: a randomized controlled trial
Dutheil, Frederic, Lac, Gerard, Courteix, Daniel, Dore, Eric, Chapier, Robert, Roszyk, Laurence, Sapin, Vincent and Lesourd, Bruno. (2012). Treatment of Metabolic syndrome by combination of physical activity and diet needs an optimal protein intake: a randomized controlled trial. Nutrition Journal. 11(1). https://doi.org/10.1186/1475-2891-11-72