The Efficacy and Safety of Dexamethasone Intracanalicular Insert Use in Patients with Chronic Seasonal/Perennial Allergic Conjunctivitis: A Systematic Review and Meta-Analysis.

Objective: This meta-analysis evaluated the efficacy and safety of DEXTENZA, an intracanalicular dexamethasone insert, for the treatment of seasonal/perennial allergic conjunctivitis.

Methods: Multiple databases, including PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, the Directory of Open Access Journals, and Scopus, were searched for randomized controlled trials (RCTs) comparing the efficacy of DEXTENZA with a placebo. The primary efficacy endpoint was the change in the conjunctival allergen challenge (CAC) model. The GRADE approach was used to assess the certainty of evidence, and the revised Cochrane risk of bias tool for randomized trials was employed to assess bias.

Results: Four RCTs involving 323 participants met the eligibility criteria, and all had a low risk of bias. A meta-analysis revealed a statistically significant increase in the mean CAC change for conjunctival itching, with low heterogeneity among measurements at 3 minutes (P < 0.00001, I2 = 47%), 5 minutes (P < 0.00001, I2 = 46%), and 7 minutes (P < 0.00001, I2 = 41%). Additionally, the meta-analysis found a statistically significant increase in the mean CAC change for conjunctival redness with low heterogeneity (P < 0.00001, I2 = 15%). The pooled analysis showed no significant difference (P = 0.57, I2 = 0%) between the DEXTENZA and placebo groups in the frequency of adverse events.

Conclusion: DEXTENZA has emerged as a promising and viable treatment option for patients with seasonal/perennial allergic conjunctivitis and is an effective alternative to current therapeutic modalities.