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Published in: Graefe's Archive for Clinical and Experimental Ophthalmology 6/2019

01-06-2019 | Doxycycline | Medical Ophthalmology

Efficacy of azithromycin 1.5% eyedrops vs oral doxycycline in meibomian gland dysfunction: a randomized trial

Authors: Vannarut Satitpitakul, Kitiya Ratanawongphaibul, Ngamjit Kasetsuwan, Usanee Reinprayoon

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 6/2019

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Abstract

Purpose

To determine the efficacy of azithromycin 1.5% eyedrops compared with oral doxycycline in patients with moderate to severe meibomian gland dysfunction (MGD).

Methods

This prospective randomized trial included 169 participants with newly diagnosed moderate to severe MGD. Participants were randomly assigned to treatment with azithromycin 1.5% eyedrops (n = 85) twice daily for 2 days then once daily until 4 weeks or oral doxycycline (n = 84) 100 mg twice daily for 4 weeks. Signs and symptoms of MGD were evaluated at baseline and 4 weeks later. The percentages of participants with improvement in meibum quality were assessed as a primary outcome. Secondary outcomes were MGD-related symptoms, meibum expressibility, Oxford ocular surface staining score, tear film break up time (TBUT), and drug side effects.

Results

Although there were significant improvements in all outcomes in both groups, there was no between-group differences in the percentages of participants with improved meibum quality (P = 0.80), MGD-related symptoms (P > 0.05), meibum expressibility (P = 0.92), Oxford ocular surface staining score (P = 0.59), and TBUT (P = 0.99). Five (5.88%) participants in azithromycin group and four (4.76%) participants in doxycycline group discontinued medications due to drug side effects (P = 0.75).

Conclusions

Both azithromycin 1.5% eyedrops and oral doxycycline significantly improved signs and symptoms in patients with moderate to severe MGD. Both azithromycin 1.5% eyedrops and oral doxycycline showed no difference in term of improved signs and symptoms of MGD as well as drug side effects that lead to discontinuation of medication.
Literature
1.
go back to reference Schaumberg DA, Nichols JJ, Papas EB, Tong L, Uchino M, Nichols KK (2011) The international workshop on meibomian gland dysfunction: report of the subcommittee on the epidemiology of, and associated risk factors for, MGD. Invest Ophthalmol Vis Sci 52:1994–2005CrossRefPubMedPubMedCentral Schaumberg DA, Nichols JJ, Papas EB, Tong L, Uchino M, Nichols KK (2011) The international workshop on meibomian gland dysfunction: report of the subcommittee on the epidemiology of, and associated risk factors for, MGD. Invest Ophthalmol Vis Sci 52:1994–2005CrossRefPubMedPubMedCentral
2.
go back to reference Olenik A, Mahillo-Fernandez I, Alejandre-Alba N, Fernandez-Sanz G, Perez MA, Luxan S, Quintana S, Martinez de Carneros Llorente A, Gracia-Sandoval B, Jimenez-Alfaro I (2014) Benefits of omega-3 fatty acid dietary supplementation on health-related quality of life in patients with meibomian gland dysfunction. Clin Ophthalmol 8:831–836CrossRefPubMedPubMedCentral Olenik A, Mahillo-Fernandez I, Alejandre-Alba N, Fernandez-Sanz G, Perez MA, Luxan S, Quintana S, Martinez de Carneros Llorente A, Gracia-Sandoval B, Jimenez-Alfaro I (2014) Benefits of omega-3 fatty acid dietary supplementation on health-related quality of life in patients with meibomian gland dysfunction. Clin Ophthalmol 8:831–836CrossRefPubMedPubMedCentral
3.
go back to reference Nichols KK, Foulks GN, Bron AJ, Glasgow BJ, Dogru M, Tsubota K, Lemp MA, Sullivan DA (2011) The international workshop on meibomian gland dysfunction: executive summary. Invest Ophthalmol Vis Sci 52:1922–1929CrossRefPubMedPubMedCentral Nichols KK, Foulks GN, Bron AJ, Glasgow BJ, Dogru M, Tsubota K, Lemp MA, Sullivan DA (2011) The international workshop on meibomian gland dysfunction: executive summary. Invest Ophthalmol Vis Sci 52:1922–1929CrossRefPubMedPubMedCentral
4.
go back to reference Foulks GN, Borchman D, Yappert M, Kakar S (2013) Topical azithromycin and oral doxycycline therapy of meibomian gland dysfunction: a comparative clinical and spectroscopic pilot study. Cornea 32:44–3253CrossRefPubMedPubMedCentral Foulks GN, Borchman D, Yappert M, Kakar S (2013) Topical azithromycin and oral doxycycline therapy of meibomian gland dysfunction: a comparative clinical and spectroscopic pilot study. Cornea 32:44–3253CrossRefPubMedPubMedCentral
5.
go back to reference Kashkouli MB, Fazel AJ, Kiavash V, Nojomi M, Ghiasian L (2015) Oral azithromycin versus doxycycline in meibomian gland dysfunction: a randomised double-masked open-label clinical trial. Br J Ophthalmol 99:199–204CrossRefPubMed Kashkouli MB, Fazel AJ, Kiavash V, Nojomi M, Ghiasian L (2015) Oral azithromycin versus doxycycline in meibomian gland dysfunction: a randomised double-masked open-label clinical trial. Br J Ophthalmol 99:199–204CrossRefPubMed
6.
go back to reference Veldman P, Colby K (2011) Current evidence for topical azithromycin 1% ophthalmic solution in the treatment of blepharitis and blepharitis-associated ocular dryness. Int Ophthalmol Clin 51:43–52CrossRefPubMed Veldman P, Colby K (2011) Current evidence for topical azithromycin 1% ophthalmic solution in the treatment of blepharitis and blepharitis-associated ocular dryness. Int Ophthalmol Clin 51:43–52CrossRefPubMed
7.
go back to reference Opitz DL, Tyler KF (2011) Efficacy of azithromycin 1% ophthalmic solution for treatment of ocular surface disease from posterior blepharitis. Clin Exp Optom 94:200–206CrossRefPubMed Opitz DL, Tyler KF (2011) Efficacy of azithromycin 1% ophthalmic solution for treatment of ocular surface disease from posterior blepharitis. Clin Exp Optom 94:200–206CrossRefPubMed
9.
go back to reference Thode AR, Latkany RA (2015) Current and emerging therapeutic strategies for the treatment of meibomian gland dysfunction (MGD). Drugs 75:1177–1185CrossRefPubMed Thode AR, Latkany RA (2015) Current and emerging therapeutic strategies for the treatment of meibomian gland dysfunction (MGD). Drugs 75:1177–1185CrossRefPubMed
10.
go back to reference Akpek EK, Vittitow J, Verhoeven RS, Brubaker K, Amar T, Powell KD, Boyer JL, Crean C (2009) Ocular surface distribution and pharmacokinetics of a novel ophthalmic 1% azithromycin formulation. J Ocul Pharmacol Ther 25:433–439CrossRefPubMed Akpek EK, Vittitow J, Verhoeven RS, Brubaker K, Amar T, Powell KD, Boyer JL, Crean C (2009) Ocular surface distribution and pharmacokinetics of a novel ophthalmic 1% azithromycin formulation. J Ocul Pharmacol Ther 25:433–439CrossRefPubMed
11.
go back to reference Foulks GN, Borchman D, Yappert M, Kim SH, KcKay JW (2010) Topical azithromycin therapy for meibomian gland dysfunction: clinical response and lipid alterations. Cornea 29:781–788CrossRefPubMedPubMedCentral Foulks GN, Borchman D, Yappert M, Kim SH, KcKay JW (2010) Topical azithromycin therapy for meibomian gland dysfunction: clinical response and lipid alterations. Cornea 29:781–788CrossRefPubMedPubMedCentral
12.
go back to reference (2007) Methodologies to diagnose and monitor dry eye disease: report of the Diagnostic Methodology Subcommittee of the International Dry Eye WorkShop. Ocul Surf 5:108–52 (2007) Methodologies to diagnose and monitor dry eye disease: report of the Diagnostic Methodology Subcommittee of the International Dry Eye WorkShop. Ocul Surf 5:108–52
13.
go back to reference Haque RM, Torkildsen GL, Brubaker K, Zink RC, Kowalski RP, Mah FS, Pflugfelder SC (2010) Multicenter open-label study evaluating the efficacy of azithromycin ophthalmic solution 1% on the signs and symptoms of subjects with blepharitis. Cornea 29:871–877CrossRefPubMed Haque RM, Torkildsen GL, Brubaker K, Zink RC, Kowalski RP, Mah FS, Pflugfelder SC (2010) Multicenter open-label study evaluating the efficacy of azithromycin ophthalmic solution 1% on the signs and symptoms of subjects with blepharitis. Cornea 29:871–877CrossRefPubMed
14.
go back to reference Mantelli F, Lee DC, Chang MH (2013) Topical azithromycin as a novel treatment for ocular rosacea. Ocul Immunol Inflamm 21:371–377CrossRefPubMed Mantelli F, Lee DC, Chang MH (2013) Topical azithromycin as a novel treatment for ocular rosacea. Ocul Immunol Inflamm 21:371–377CrossRefPubMed
15.
go back to reference Yoo SE, Lee DC, Chang MH (2005) The effect of low-dose doxycycline therapy in chronic meibomian gland dysfunction. Korean J Ophthalmol 19:258–263CrossRefPubMed Yoo SE, Lee DC, Chang MH (2005) The effect of low-dose doxycycline therapy in chronic meibomian gland dysfunction. Korean J Ophthalmol 19:258–263CrossRefPubMed
16.
go back to reference Knop E, Knop N, Millar T, Obata H, Sullivan DA (2011) The international workshop on meibomian gland dysfunction: report of the subcommittee on anatomy, physiology, and pathophysiology of the meibomian gland. Invest Ophthalmol Vis Sci 52:1938–1978CrossRefPubMedPubMedCentral Knop E, Knop N, Millar T, Obata H, Sullivan DA (2011) The international workshop on meibomian gland dysfunction: report of the subcommittee on anatomy, physiology, and pathophysiology of the meibomian gland. Invest Ophthalmol Vis Sci 52:1938–1978CrossRefPubMedPubMedCentral
17.
go back to reference Geerling G, Tauber J, Baudouin C, Goto E, Matsumoto Y, O’Brien T, Rolando M, Tsubota K, Nichols KK (2011) The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction. Invest Ophthalmol Vis Sci 52:2050–2064CrossRefPubMedPubMedCentral Geerling G, Tauber J, Baudouin C, Goto E, Matsumoto Y, O’Brien T, Rolando M, Tsubota K, Nichols KK (2011) The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction. Invest Ophthalmol Vis Sci 52:2050–2064CrossRefPubMedPubMedCentral
18.
go back to reference Zhang L, Su Z, Zhang Z, Lin J, Li DQ, Pflugfelder SC (2015) Effects of azithromycin on gene expression profiles of proinflammatory and anti-inflammatory mediators in the eyelid margin and conjunctiva of patients with meibomian gland disease. JAMA Ophthalmol 133:1117–1123CrossRefPubMedPubMedCentral Zhang L, Su Z, Zhang Z, Lin J, Li DQ, Pflugfelder SC (2015) Effects of azithromycin on gene expression profiles of proinflammatory and anti-inflammatory mediators in the eyelid margin and conjunctiva of patients with meibomian gland disease. JAMA Ophthalmol 133:1117–1123CrossRefPubMedPubMedCentral
19.
go back to reference Liu Y, Kam WR, Ding J, Sullivan DA (2015) Can tetracycline antibiotics duplicate the ability of azithromycin to stimulate human meibomian gland epithelial cell differentiation? Cornea 34:342–346CrossRefPubMedPubMedCentral Liu Y, Kam WR, Ding J, Sullivan DA (2015) Can tetracycline antibiotics duplicate the ability of azithromycin to stimulate human meibomian gland epithelial cell differentiation? Cornea 34:342–346CrossRefPubMedPubMedCentral
Metadata
Title
Efficacy of azithromycin 1.5% eyedrops vs oral doxycycline in meibomian gland dysfunction: a randomized trial
Authors
Vannarut Satitpitakul
Kitiya Ratanawongphaibul
Ngamjit Kasetsuwan
Usanee Reinprayoon
Publication date
01-06-2019
Publisher
Springer Berlin Heidelberg
Published in
Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 6/2019
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI
https://doi.org/10.1007/s00417-019-04322-1

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