2 The technology
2.1 Ciclosporin (Ikervis, Santen Pharmaceutical) is a sterile, positively charged, oil‑in water, unpreserved ophthalmic emulsion that contains ciclosporin (CsA). Its formulation contains an excipient, cetalkonium chloride, which acts as a cationic agent and is specifically designed to prolong the time each eye drop stays on the epithelial layer of the eye. Ciclosporin has an anti‑inflammatory effect on the cornea and the lacrimal (tear) gland. Following administration, ciclosporin blocks the expression of pro‑inflammatory cytokines and subsequently enters corneal and conjunctival infiltrated T‑cells, activating them. It has a marketing authorisation in the UK for treating 'severe keratitis in adult patients with dry eye disease, which has not improved despite treatment with tear substitutes'. Ciclosporin is administered as an eye drop of 1 mg/ml once daily at bed time.
2.2 The acquisition cost of a monthly course of ciclosporin is £72 (excluding VAT). Costs may vary in different settings because of negotiated procurement discounts.
2.3 The most common adverse reactions with ciclosporin are eye pain, eye irritation, lacrimation, ocular hyperaemia and eyelid erythema. For full details of adverse reactions and contraindications, see the summary of product characteristics.