White is an anterior segment surgeon and founder of SkyVision Centers in Westlake, Ohio.
Disclosures: White reports consulting for Aldeyra, Allergan, Avellino, Bausch + Lomb, Johnson & Johnson, Kala, Novartis, Orasis, Rendia, Santen, Sight Sciences, Sun, Tarsus and TearLab; speaking for Allergan, Kala, Novartis, Santen and Sun; and having ownership interest in Orasis.
Rumors swirled around the exhibit floor and coursed through gatherings of dry eye disease docs who attended the American Society of Cataract and Refractive Surgery meeting.
A big old “other shoe” floated above Kala, and we all waited for it to drop. Unlike Sun, the other company that launched a major new medication just in time to get crushed by the pandemic, Kala’s launch of Eysuvis (loteprednol etabonate ophthalmic suspension 0.25%) was a live or die event. From early in its development, a low-dose, vehicle-driven value proposition in the dry eye disease (DED) space was the rationale for Kala’s commercial program.
And then came COVID.
Don’t get me wrong — I’m sympathetic to the challenges that Sun has faced bringing the third branded immunomodulator (another vehicle-driven play) to market. It’s just that it has other eye meds to sell, as well as a full complement of products for other areas of medicine. Kala’s road was the “eye” road, and the pandemic laid ’em low. It’s an even bigger bummer given all of the truly innovative things that Kala brought to the space, especially its work in defining the common symptom arc of flare-ups interspersed with times of relative comfort. While most of us sorta, kinda knew this already, Kala gave us the vocabulary to discuss this pattern and a safe, reliable option to treat these flare-ups.
Press releases on May 23 announced that Alcon — yes, that Alcon — would acquire both Eysuvis and Inveltys (loteprednol etabonate ophthalmic suspension 1%). I did a Google search, looking to see what other branded medications Alcon is making and selling now. Bupkis. Novartis kept the whole kit and caboodle when it spun out Alcon a couple of years ago. What remains is the Systane artificial tear franchise. Alcon picked up iLux in 2018, so along with the Systane franchise, the acquisition of Eysuvis makes sense. While I have no insight regarding Alcon’s plans, I can’t imagine that this is the last move it is planning to make in the DED space.
As I noted in my post on the newly public Bausch + Lomb, the eye care world is generally healthier with a robust Alcon in the mix. Not gonna lie, though, I feel badly for the team at Kala. They did the work necessary to get the first steroid with an on-label indication for DED, and they reshaped the whole space with the intermittent flare narrative. You really have to wonder if things would have been different if they’d been able to launch Eysuvis in normal times.
I can’t help thinking they deserved better.