TARSUS PHARMACEUTICAL INC.'S Xdemvy (lotilaner ophthalmic solution) 0.25%, formerly known as TP-03, is a novel prescription eye drop designed to treat Demodex blepharitis by targeting and eradicating the root cause of the disease—Demodex mite infestation. The active ingredient in Xdemvy is lotilaner, a molecule that is highly lipophilic, which may promote its uptake in the oily sebum of the eyelash follicles where the mites reside, according to Tarsus.

Here, practitioners share their clinical experiences.

Please tell us about your experience with Xdemvy.

Janelle Davison, OD, who practices in Smyrna, GA, had patients lined up who she thought would be good candidates. “We were using some of the traditional methods to manage Demodex in the office…but I had some recalcitrant cases [that] just weren’t improving,” she says. “In the beginning, I had patients come back…who were getting to a clinical endpoint of grade 0. So, it was almost too good to be true. Of course, I’ve had one or two who needed a second script, but those were my toughest cases for years.”

Who are the best candidates?

For Patrick Vollmer, OD, who practices in Shelby, NC, the best candidates are those who have clinically significant Demodex blepharitis. “I would be inclined to treat a grade 2. However, I would treat under that level if a patient was symptomatic with itching, burning, stinging, things like that,” he says.

Please tell us about the prescribing process.

Dr. Vollmer explains that Xdemvy is really designed for acute treatment versus off-and-on therapy. “I have given patients a refill of the drug if they went from grade 4 collarettes, where we see about two-thirds of the upper lid that’s been infected with the Demodex infestation, to grade 2, and I want to get them from a grade 2 to grade 0,” he notes.

How has Xdemvy helped with troubleshooting?

According to Dr. Davison, Demodex infestation could be masking an underlying cause. She explains that she looks at everything during exams. “I’m looking at the lid margin looking for signs. I know that certain things usually come together,” she says.

Tell us about any success stories.

Dr. Vollmer recounts the story of a patient in their mid-30s who kept having recurrent styes, which led to chalazia and really inflamed lids. They had to go to ocular plastics once or twice a year to get their chalazion cut out. They also had tried different oral antibiotics, had lots of lid scrubs, and tried various steroid antibiotic creams and drops. “They just weren’t getting any better,” he notes. “A couple months ago, I put the patient on Xdemvy and they went from grade 3 or 4 down to less than a grade 1.

“They explained that previously their eyes were always bothering them, they thought about it all the time, and now they feel tremendously better. They haven’t had any styes in months,” he adds.

Dr. Davison tells of a nontraditional patient. “The patient came in for a routine exam. We offered ocular surface screening and took pictures of the front part of the eye,” she says. “We could see that she had Demodex. My goal was to get the patient to stop wearing fake lashes, but she wouldn’t.”

So, Dr. Davison told her there was a therapy that would allow her to keep her lashes and would at least reduce this bacterial load on her eyes. “I prescribed Xdemvy. When she came back in, we repeated her tear breakup time tests and anterior segment images, and the patient could see the difference. She said her eyes felt better and they are less red. She also thought her lashes looked better overall.

“It turns out the enhancement that she was paying for was obstructed by all of the bacteria, collarettes, and mites. She was ecstatic that I had an option that would improve her symptoms but not stop her style,” adds Dr. Davison.