Efficacy of Bepotastine versus Olopatadine Ophthalmic Solutions in Mild to Moderate Vernal Keratoconjunctivitis as a Sole Therapy

Abstract

Introduction: Vernal Keratoconjunctivitis (VKC) is a chronic, seasonally exacerbated allergic ocular inflammation of the conjunctiva. It affects predominantly the school going male population and is not so common. There is a paucity of comparative studies on efficacies of dual-action topical agents having both antihistamine and mast cell stabilizing properties. These are currently the first line drugs in the management of mild to moderate VKC. Aim: To compare the efficacy and safety of bepotastine besilate 1.5% and olopatadine Hydrochloride (HCl) 0.1%, ophthalmic solutions in mild to moderate VKC patients. Materials and Methods: This prospective, comparative study was conducted in the Ophthalmology Department at National Institute of Medical Sciences Hospital, Jaipur, Rajasthan, India, from January 2020 to January 2021. It included 76 patients having mild to moderate VKC who were randomized into two groups of 38 patients each. Each group was assigned to be treated with one of the two treatment options namely bepotastine besilate 1.5% and olopatadine HCl 0.1% ophthalmic solutions. Typical symptoms and signs of VKC like ocular itching, watering, mucoid discharge, conjunctival hyperaemia and tarsal papillary hypertrophy were recorded at baseline and at the time of followup on 7th day, 15th and 30th day using simplified scoring 4-point scales ranging from 0-3. Safety assessment was also done. Friedman’s test and Mann-Whitney’s U test were performed for intra-arm and inter-arm analysis of continuous variables respectively. Nominal categorical data between the groups were compared using the Chi-square test. The p-value <0.05 was considered as statistically significant. Results: The mean age of the participants was 10.49 ± 2.95 years and the male to female ratio (M:F) was 1.7:1. After 30 days of drug therapy, patients in both arms showed significant improvement in the symptoms and signs scoring of VKC. There was no statistically significant difference in efficacy on interarm analysis at baseline and subsequent follow-ups. Almost all patients became free from their symptoms and signs at the end of the study. However, 25 of 38 (65.8%) patients in bepotastine treated group and 23 of 38 (60.5%) patients in olopatadine treated group had residual tarsal papillae. None of the patients in either group reported any significant adverse effects. Conclusion: Both bepotastine besilate 1.5% and olopatadine HCl 0.1% ophthalmic solutions are safe and equally effective in alleviating the clinical symptoms and signs of mild to moderate VKC.