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Review
. 2025 Apr 28;15(1):39.
doi: 10.1186/s12348-025-00497-3.

Reproxalap in patients with seasonal allergic conjunctivitis: a systematic review and meta-analysis

Ammar Elgadi  1 , Malaz M Abdalmotalib  2 , Tibyan Noorallah  2 , Egbal Abdelazim  2 , Fatma Ali Merghani Mohammed  2
Affiliations
Review

Reproxalap in patients with seasonal allergic conjunctivitis: a systematic review and meta-analysis

Ammar Elgadi et al. J Ophthalmic Inflamm Infect. .

Abstract

Introduction: Seasonal allergic conjunctivitis (SAC) is a hypersensitivity condition characterized by itching, tearing, and redness. It affects over 20% of the general population with limited therapeutic options. Reproxalap, a novel small-molecule aldehyde trap, has emerged as a potential treatment option for SAC by targeting reactive aldehydes involved in inflammation. In this systematic review and meta-analysis, we assessed the efficacy and safety of Reproxalap in treating SAC.

Methods: Multiple databases were searched including PubMed, Cochrane Library, Scopus, and Google Scholar, to identify relevant studies. Clinical trials involving patients diagnosed with SAC and treated with Reproxalap (0.25% or 0.5%) were included. The primary outcomes were symptom relief (efficacy) and side effects (safety). Data extraction and risk of bias assessment were performed independently by two reviewers. Meta-analysis was conducted using RevMan 5.4 software.

Results: Five RCTs involving 625 participants were included. Reproxalap significantly reduced ocular itching compared to control groups for both 0.25% (SMD: -0.31, 95% CI: -0.50 to -0.13, P = .001) and 0.5% concentrations (SMD: -0.31, 95% CI: -0.51 to -0.10, P = 0.004). No significant difference was observed between the two doses (SMD: -0.02, 95% CI: -0.23 to 0.19, P = 0.83). Side effects were more frequent in both Reproxalap groups compared to controls, with odds ratios of 35.31 (95% CI: 17.83 to 69.90, P < 0.00001) for 0.25% and 45.64 (95% CI: 18.49 to 112.66, P < 0.00001) for 0.5%. The 0.5% dose had significantly higher odds of side effects compared to the 0.25% dose (OR: 1.66, 95% CI: 1.10 to 2.51, P = 0.02). Heterogeneity was low for all outcomes (I2 = 0%).

Conclusion: Reproxalap reduces ocular itching associated with SAC. While both 0.25% and 0.5% concentrations are effective, safe and tolerable. Further research should focus on the long-term benefits and applicability of Reproxalap on diverse populations.

Keywords: Meta-analysis; Ocular itching; Reactive aldehyde species; Reproxalap; Seasonal allergic conjunctivitis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval was waived as this was a secondary analysis of online data. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram showing the study selection process. From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71
Fig. 2
Fig. 2
Risk of bias assessment using ROB2. * D1: Randomisation process, D2: Deviations from the intended interventions, D3: Missing outcome data, D4: Measurement of the outcome, D5: Selection of the reported result
Fig. 3
Fig. 3
Forest plot comparing the effect of reproxalap 0.25% and 0.5% on ocular itching scores against control. a Reproxalap 0.25% vs. control. b Reproxalap 0.5% vs. control (c) Reproxalap 0.25% vs. 0.5%
Fig. 4
Fig. 4
Forest plot comparing the effect of reproxalap 0.25% and 0.5% on ocular side effects against control. a Reproxalap 0.25% vs. control. b Reproxalap 0.5% vs. control (c) Reproxalap 0.25% vs. 0.5%
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