title: Comparison of the effects of ketotifen fumarate 0.025% and olopatadine HCl 0.1% ophthalmic solutions in seasonal allergic conjunctivities: a 30-day, randomized, double-masked, artificial tear substitute-controlled trial.
abstract: BACKGROUND
  Topical antiallergic agents, such as antihistamines and mast-cell stabilizers, are the main therapeutic options for seasonal allergic conjunctivitis (SAC). Ketotifen fumarate and olopatadine HCl have dual action that offers a combination of these 2 mechanisms. Although clinical studies comparing the efficacy of these 2 drugs have shown that both were effective in the treatment of SAC, the results were contradictory and did not include the effects of these drugs on inflammatory markers.
  
  
  OBJECTIVE
  The aims of this study were to compare the clinical efficacy of topical ketotifen and olopatadine eye drops and to determine the effects of these 2 drugs on the expression of cell adhesion molecules (CAMs) and inflammatory markers in conjunctival surface cells in patients with SAC.
  
  
  METHODS
  This 30-day, randomized, double-masked, artificial tear substitute (ATS)-controlled clinical trial was conducted at the Department of Ophthalmology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey. Patients with SAC were included in the study and randomly assigned to 1 of 3 groups: topical ketotifen fumarate 0.025% ophthalmic solution, topical olopatadine HCl 0.1% ophthalmic solution, or ATS (control group). All drugs were administered 2 drops per eye BID for 30 days. At the beginning of the study (day 0; baseline), on day 15, and on day 30, clinical scores (itching, tearing, redness, eyelid, swelling, and chemosis) and conjunctival impression cytology specimens were obtained. The percentages of cells expressing intercellular adhesion molecule 1, vascular CAM-1, human leukocyte antigen-DR, and beta1-integrin (CD29) from conjunctival impression cytology specimens were determined using flow cytometry. Patients were questioned about adverse events (AEs) at each visit. Ocular discomfort on installation of the drugs was recorded as an AE.
  
  
  RESULTS
  Thirty-nine patients (20 men, 19 women; age range, 18-61 years) with SAC were included. Twelve patients received ketotifen; 13, olopatadine; and 14, ATS. In both active-treatment groups, the improvements of clinical scores (tearing and itching) were more pronounced compared with those in the ATS group, although the day-30 difference in tearing score between the olopatadine and ATS groups was not statistically significant. No significant within-group or between-group differences in mean scores for redness, chemosis, or eyelid swelling were found. The expression rates of CAMs and inflammatory markers in conjunctival surface cells were significantly more reduced with ketotifen and olopatadine compared with ATS. However, clinical and flow cytometric parameters were improved with ATS at 15 and 30 days compared with baseline. No AEs were observed during the study period.
  
  
  CONCLUSIONS
  In this short-term study in a selected, small study population with SAC, ketotifen and olopatadine diminished the expression of CAMs and inflammatory markers on the conjunctival surface cells effectively. Both active treatments were more efficacious compared with ATS and were well tolerated.
authors.affiliation: Department of Ophthalmology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey. avunduk@ttnet.net.tr
authors.forename: Avni Murat
authors.initials: AM
authors.lastname: Avunduk
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Tekelioglu
authors.forename: Adem
authors.initials: A
authors.lastname: Turk
authors.forename: Nurettin
authors.initials: N
authors.lastname: Akyol
mesh_terms: D000293:Adolescent; D000328:Adult; D018926:Anti-Allergic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015815:Cell Adhesion Molecules / Q000378:metabolism; D003228:Conjunctiva / Q000187:drug effects* / Q000276:immunology / Q000378:metabolism; D003233:Conjunctivitis, Allergic / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D003990:Dibenzoxepins / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006684:HLA-DR Antigens / Q000378:metabolism; D006801:Humans; D019012:Integrin beta1 / Q000378:metabolism; D007665:Ketotifen / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D000069605:Olopatadine Hydrochloride; D009883:Ophthalmic Solutions; D011537:Pruritus / Q000188:drug therapy; D012621:Seasons; D013666:Tears / Q000187:drug effects / Q000378:metabolism; D013997:Time Factors
chemical_list: D018926:Anti-Allergic Agents; D015815:Cell Adhesion Molecules; D003990:Dibenzoxepins; D006684:HLA-DR Antigens; D019012:Integrin beta1; D009883:Ophthalmic Solutions; D000069605:Olopatadine Hydrochloride; D007665:Ketotifen