Efficacy and Safety of Lotilaner Ophthalmic Solution (0.25%) for the Treatment of Demodex Blepharitis: A GRADE Assessed Systematic Review and Meta-Analysis of Observational & Experimental Studies.

PURPOSE: This review aims to assess the safety and efficacy of Lotilaner in the treatment of Demodex Blepharitis.

DESIGN: Systematic Review and Meta-Analysis BACKGROUND: Demodex blepharitis is a common eye condition that arises from Demodex mites infestation within the hair follicles of eyelashes, resulting in detrimental effects. The disease affects a significant part of the general population, including general eye care patients and individuals diagnosed with blepharitis. Several treatments have been in use before the discovery of lotilaner, like tea tree oil, and antibiotics; however, they either have irritable effects or systemic adverse effects, respectively. Lotilaner, a novel ectoparasiticide, has been proposed as a treatment for patients grappling with Demodex blepharitis. We primarily aimed to assess the efficacy and safety of Lotilaner for the treatment of Demodex blepharitis.

METHODS: An extensive search was conducted on PubMed, Cochrane Library, Scopus, and Google Scholar to find relevant literature till 31 July 2023 following the PRISMA guidelines. A total of 143 articles were retrieved by database searching, out of which 6 studies met the inclusion criteria and were included in the review. Four RCTs were included in the meta-analysis of mite eradication incidence. The review is registered with PROSPERO: CRD42023459997.

RESULTS: Lotilaner is effective in eradicating Demodex mites in individuals suffering from Demodex blepharitis according to RR for the intervention versus the control group of 3.55 (95% CI: 2.87 ‒ 4.40, P < 0.00001, I2  = 0%). The meta-analysis of clinically meaningful collarette score revealed the summary RR for the intervention versus the control group was 3.15 (95% CI: 2.56 ‒ 3.89, P < 0.00001, I2  = 27%). In conclusion, the results of the included studies were comparable and consistent.

CONCLUSIONS: Our results indicated that Lotilaner is an effective, well-tolerated, and promising drug in treating patients with Demodex blepharitis. Lotilaner administration and cost-effectiveness should now be contemplated for the study population as these constituents have a vital impact on its treatment success.