Therapeutic Focus

Dry Eye and Sjögren syndrome: Tens of millions of patients worldwide suffer from dry eye. It is considered to be the second most frequent eye condition in the developed world after conjunctivitis and is estimated at 20% of the global ophthalmology market. There are two main causes: decreased secretion of tears by the lacrimal (tear-producing) glands and loss of tears due to excess evaporation. Both can lead to ocular surface discomfort, often described as feelings of dryness, burning, a sandy/gritty sensation, or itchiness. Visual fatigue, sensitivity to light, and blurred vision are also characteristic of dry eye. In people with dry eye, thin spots in the tear film may appear and the tears no longer adequately protect and support the health of ocular surface tissues. Current treatment relies on an almost permanent use of artificial tears and on punctual use of immunosuppressant drugs like cyclosporine or corticosteroids although their use is limited as they induce a rise in ocular pressure. The market for dry eye is estimated to reach CHF 2 billion in 2016.

One of the causes of dry eye is associated with Sjögren’s syndrome, an autoimmune disease with leading clinical manifestations of dry eye, dry mouth and articular pains and discomfort. For Sjögren’s syndrome patients, inflammation of tear-secreting glands reduces tear production, resulting in chronic dry eye. In addition, changes in the composition of tears contribute to the symptom aggravation. For this reason dry eye associated with Sjogren’s syndrome represents a very good clinical model of dry eye as this patient population is much more homogeneous than the dry eye-suffering general population and the trial will enrolled much less patients. No treatment is available for more sustainable control of dry eye associated with Sjogren’s syndrome and the market for this indication is estimated to reach above CHF300 million in 2014.

Uveitis is a serious condition, potentially leading to permanent vision loss. It is the third most frequent cause of blindness in the developed world. Uveitis is an inflammation of the uvea, the middle layer of the eye. The uvea consists of the iris, choroid and ciliary body. The choroid is sandwiched between the retina and the white of the eye (sclera), and it provides blood flow to the deep layers of the retina. The most common type of uveitis is an inflammation of the iris called iritis or anterior uveitis. Infections, injury and autoimmune disorders may be associated with the development of uveitis, though the exact cause is often unknown. The signs, symptoms and characteristics of uveitis include eye redness and pain, light sensitivity, dark floating spots in the field of vision (floaters) and decreased vision. The mainstay of the treatment are still topical or intra-vitreal injectable corticoids and for more severe cases immunosuppressant and cytotoxic drugs like methotrexate. Needless to stress that both of those drug classes can cause severe and frequent adverse effects like repeated infections and increased intra-ocular eye pressure (glaucoma) which are severe and long-lasting complications. The market for uveitis is foreseen to reach CHF1.6 billion in 2016.

Atopic dermatitis, also known as eczema is a chronic, itchy skin condition that is very common in children but may occur at any age. It is the most common form of dermatitis affecting 15-20% of children and 2-4% of adults. Atopic eczema usually occurs in people who have an 'atopic tendency'. This means they may develop any or all of three closely linked conditions; atopic eczema, asthma and hay fever (allergic rhinitis).
Atopic eczema arises because of a complex interaction of genetic and environmental factors. These include defects in skin barrier function making the skin more susceptible to irritation by soap and other contact irritants, polluting agents, temperature etc. Most people have acute flares with inflamed, red, sometimes blistered and weepy patches. In between flares, the skin may appear either normal or suffer from chronic eczema with dry, thickened and itchy areas. The treatment may be repeatedly required for many months and possibly years. On top of skin moisturizers, here again the treatment relies on topical-, and for more severe cases, oral corticosteroids. Calcineurin inhibitors such as pimecrolimus cream are sometimes used and in longstanding, resistant forms some immunosuppressant agents like methotrexate or azathioprine are needed. The market for atopic dermatitis is expected to be around CHF 840 million in 2016.