Rx Perspectives

Lastacaft: Allergy Relief That Lasts All Day

By Carlos Buznego, MD

As ophthalmologists begin to see the annual influx of seasonal allergic conjunctivitis patients return to our practices, we are fortunate to have a new option to offer: Lastacaft (alcaftadine ophthalmic solution, 0.25%) a new medication for the treatment of allergic conjunctivitis, which has been released by Allergan. It is a potent medication with a once-daily indication. Lastacaft is an H1 histamine receptor antagonist indicated for the prevention of itching associated with allergic conjunctivitis. Alcaftadine also inhibits the release of histamine from mast cells, decreases chemotaxis and inhibits eosinophil activation.

Conjunctival allergen challenge (CAC) studies were used to evaluate the efficacy of alcaftadine in the FDA pivotal trials. CAC testing involves challenging a subject's eye to a known allergen and confirming a significant allergic response. The onset and duration of the test medication are then studied.

To determine how quickly the medication works, the subject is pretreated with the test agent 15 minutes prior to the known allergen challenge. Itching scores are reported at three, five and seven minutes post challenge. In order to determine the duration of effect, test agent is instilled 16 hours prior to allergen challenge and again itching scores are recorded at three, five and seven minutes post challenge. Three randomized, placebo-controlled trials (n=274 patients) demonstrated that Lastacaft significantly reduces itching compared to vehicle. The onset of the therapeutic effect was found as early as three minutes post CAC. The duration of therapeutic effect was shown for at least 16 hours following Lastacaft dosing (Figure 1).^1-3

Results of clinical efficacy trials demonstrating duration of effect in patients treated with Lastacaft vs. vehicle.

In addition to safety data from the three clinical trials, an additional trial was performed in 909 healthy adults. Lastacaft was found to have an excellent safety profile. The most frequent ocular adverse reactions, occurring in <4% of Lastacaft-treated eyes, were eye irritation, burning and/or stinging upon instillation, eye redness and eye pruritis.⁴ The most frequent nonocular adverse reactions, occurring in <3% of subjects with Lastacaft-treated eyes, were naso pharyngitis, headache and influenza. Some of these events were similar to the underlying disease being studied.

Lastacaft is approved for use in patients two years of age and older. It is classified as a pregnancy category B product and caution should be exercised when Lastacaft is administered to a nursing woman.

Clinical Insights on Use

I have utilized Lastacaft for patients with ocular allergies since its initial release. Dosed only once daily, I have found it to be quite effective in controlling ocular itching as well as relieving other associated symptoms such as redness, swelling and tearing. In the past, I have found that some “problem patients” with allergic conjunctivitis may require a topical steroid in addition to an antihistamine drop. So far I have found that Lastacaft monotherapy has efficiently controlled this tough subset of patients.

Lastacaft is a welcome addition to the armamentarium of clinicians treating ocular allergies. It is a potent topical medication and only one of two such products with a once daily indication. It has a rapid onset of action, with a significant effect on itching as quickly as 15 minutes post instillation. It also has a long duration of effect, with dramatic itch relief lasting 16 hours post application. It has an excellent safety profile and should be welcomed by patients desiring relief from the troubling symptoms of allergic conjunctivitis. OM

References

1. Data on file, Allergan, Inc., 2009; Clinical Study Report 09-003-05.
2. Data on file, Allergan, Inc., 2005; Clinical Study Report 05-003-11.
3. Data on file, Allergan, Inc., 2005; Clinical Study Report 05-003-13.
4. Lastacaft Prescribing Information.

Dr. Buznego has received funding for research, consulting and/or speaking from: Allergan; Alcon; Bausch+Lomb; CXLUSA; Glaukos; Inspire Pharmaceuticals; Ista; LensAR; QLTi. He is a stockholder in RPS.

Carlos Buznego, MD is president of the Center for Excellence in Eye Care in Miami. He is also a voluntary assistant professor of ophthalmology at Bascom Palmer Eye Institute and is an active staff member of Baptist Hospital.