Effects of Lotilaner Ophthalmic Solution, 0.25% on Demodex Blepharitis Patients with Meibomian Gland Disease

Purpose: To evaluate the safety and efficacy of lotilaner ophthalmic solution, 0.25% compared with vehicle in Demodex blepharitis patients with meibomian gland disease. Patients and Methods: This was a pooled analysis of two prospective, randomized, double-masked studies of Demodex blepharitis patients with meibomian gland disease, Ersa (N=39), and Rhea (N=40). The two studies had the same design, eligibility criteria, and sample size, except Ersa studied lotilaner ophthalmic solution, 0.25% while Rhea studied the associated vehicle. Study outcomes were collarette grading, meibomian gland secretion score (MGSS), number of glands yielding any liquid secretions (MGYLS), number of glands yielding clear liquid secretions (MGYCLS), patient-reported outcomes, and adverse events (AEs). Results: On Days 43 and 85, there was a statistically significantly higher proportion of patients in the lotilaner group versus the vehicle group with collarette reduction to grade 0 (0– 2 collarettes/lid) (44.7% vs 0.0% and 65.8% vs 0.0%) and grade 0 or 1 (0– 10 collarettes/lid) (81.6% vs 8.8% and 100% vs 0.0%) (all p< 0.001). Mean MGSS, MGYLS, and MGYCLS in the lotilaner group were statistically significantly higher than in the vehicle group. The proportion of lotilaner patients achieving improvement to ≥ 3 glands with clear meibum (grade 3) was significantly higher than the vehicle group on Day 43 (44.7% vs 17.6%, p< 0.05) and Day 85 (78.9% vs 18.2%, p< 0.001). At Days 43 and 85, fluctuating vision, itching, burning, and redness were significantly better in the lotilaner group than in the vehicle group. No serious treatment-related AEs were reported. Conclusion: In patients with Demodex blepharitis and meibomian gland disease, lotilaner ophthalmic solution, 0.25% demonstrated statistically significant improvements in collarette reduction, meibomian gland function, and patient-reported outcomes at 6 and 12 weeks compared to baseline. Following lotilaner treatment, these parameters were also significantly better than vehicle at 6 and 12 weeks, with a similar safety profile. Keywords: Demodex blepharitis with meibomian gland disease, Demodex blepharitis and meibomian gland disease, meibomian gland function, meibomian glands yielding liquid secretions, collarette reduction, lotilaner, ocular surface disease