Dear Dr. Roach: I am a healthy 67-year-old woman being treated with Eylea for wet age-related macular degeneration (AMD). I have just had my second round of Eyelea, and with the pollen starting up, my eyes are beginning to itch. Is it safe to use over-the-counter eye drops? I also take Zyrtec for my interstitial cystitis.
C.H.
Eylea is used to treat several cancers as well as the “wet” form of AMD. Eylea works by preventing the formation of new blood vessels and blocking a compound called the vascular endothelial growth factor (VEGF).
In the eye, AMD causes damage by creating new blood vessels, which tend to leak. This causes blood and proteins to develop under the retina, leading to distortions in vision and affecting sight. VEGF inhibitors like Eylea can be directly injected into the vitreous humor of the eye, providing high levels of the medicine around the blood vessels and stopping new blood vessels from forming.
Because Eylea is injected directly into the vitreous humor, regular eye drops that go in the front of the eye should not interfere with its action. I did look up interactions between Eylea, Zyrtec, and several over-the-counter eye drops, and I couldn’t find any evidence of harmful interactions.
Your pharmacist also has access to the data I have and lots of experience with looking up drug interactions.
Dear Dr. Roach: I am a 78-year-old man who had a sudden severe onset of ulcerative colitis at age 66, which was confirmed by a colonoscopy. (Prior routine colonoscopies were normal.) Colonoscopies done afterward showed only minimal inflammatory changes, and I was put on mesalamine. But my symptoms remained severe with unpredictable onsets until I was put on intravenous Entyvio every two months instead.
For a full year, there was no change. Then, quite suddenly, everything became normal. I am still on Entyvio over a year later. My question is: Is it advisable, or even possible, to wean off this immunosuppressant? I cannot find any study that specifically addresses this issue. But I was told that if I discontinued Entyvio and my symptoms recurred, it might no longer be effective for me.
R.A.
Entyvio works by blocking a compound called integrin, which helps white blood cells move into the gut. Since ulcerative colitis is an inflammatory disease of the gut, mediated in large part by white blood cells, keeping them out can cause a remission of the disease.
It has much less of an effect on other infections than treatments that are designed to suppress the immune system, as it only works in the gut. It’s not really an immunosuppressant. It has few serious side-effects.
I did find a study that specifically looked at what happened to people who were in remission and voluntarily stopped Entyvio. Twenty per cent relapsed within six months; 40 per cent (cumulatively) relapsed at six months; and almost two-thirds of these subjects had relapsed at the end of 18 months. Retreatment with Entyvio was effective in about two-thirds of those who had relapsed.
If you aren’t having significant side-effects with this drug, it is inadvisable to discontinue it, as most people will relapse, and not all of them can be effectively treated again with the same drug.
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