Assessment the Safety of CyclASol compared with Vehicle and Commercially Available 0.05% Cyclosporine in Dry Eye Disease: A Systematic Review and Meta-analysis.

INTRODUCTION

To compare the safety of 0.05% and 0.1% water-free cyclosporine formulation (CyclASol) with vehicle and 0.05% cyclosporine (CsA) in patients with dry eye disease (DED).

METHODS

A systematic review with meta-analysis, reporting on the safety of CyclASol in patients with DED in three databases (PubMed, Scopus, and Web of Science until 4 April 2025), was performed according to the PRISMA statement.

RESULTS

Four randomized controlled trials (RCTs) were included, encompassing 1575 eyes from 1575 patients. The meta-analysis revealed no significant difference in the likelihood of experiencing treatment-emergent adverse events (TEAEs) between CyclASol and control groups (risk ratio [RR]: 0.98; 95% confidence interval [CI] 0.85-1.12; P = 0.72; I = 43%) (rate CyclASol: 30.3% [240 eyes]; rate controls: 30.9% [243 eyes]; rate difference: -0.6%). Similar results were observed for ocular TEAEs (RR: 1.00; 95% CI 0.78-1.30; P = 0.97; I = 0%) (rate CyclASol: 3.6% [95 eyes]; rate controls: 3.7% [93 eyes]; rate difference: -0.1%). Regarding sensitivity analyses, no significant difference in the likelihood of TEAEs was observed between CyclASol and vehicle groups (RR: 1.02; 95% CI 0.88-1.18; P = 0.83; I = 44%) (rate CyclASol: 32.5% [240 eyes]; rate vehicle: 30.3% [222 eyes]; rate difference: 2.2%). Comparable results were found for ocular TEAEs (RR: 1.07; 95% CI 0.81-1.41; P = 0.65; I = 0%) (rate CyclASol: 4.1% [95 eyes]; rate vehicle: 3.6% [85 eyes]; rate difference: 0.5%). Similarly, no statistically significant differences in TEAEs were observed when comparing CyclASol with 0.05% CsA (RR: 0.74; 95% CI 0.51-1.09; P = 0.13; I = 5%) (rate CyclASol: 29.4% [30 eyes]; rate CsA: 39.6% [21 eyes]; rate difference: -10.2%). Ocular TEAEs also remained comparable between groups (RR: 0.67; 95% CI 0.32-1.41; P = 0.29; I = 0%) (rate CyclASol: 2.8% [10 eyes]; rate CsA: 3.7% [8 eyes]; rate difference: -0.9%).

CONCLUSIONS

Based on the data presented in the meta-analysis, CyclASol is a safe treatment for patients with DED. However, the comparable likelihood of experiencing TEAEs and ocular TEAEs between CyclASol and 0.05% CsA suggests that there is not sufficient evidence to indicate a superior safety profile of CyclASol over commercially available CsA.