Postmarketing surveillance rates of uveitis and scleritis with bisphosphonates among a national veteran cohort.
OBJECTIVE
Uveitis and scleritis are the most serious ocular side effects of bisphosphonate therapy. The purpose of this study was to determine the 6-month rates of uveitis/scleritis following dispensing of bisphosphonates in a large veteran cohort.


METHODS
Two national databases (clinical and pharmacy) for fiscal year (FY) 2006 were linked to identify new diagnoses of uveitis/scleritis following the initial dispensing of bisphosphonate drugs. New diagnoses in FY 2006 were identified using International Classification of Diseases, Version 9, Clinical Modification (ICD-9-CM), in a cohort of veterans without a previous diagnosis of uveitis or scleritis using a look-back period to FY 2005. The new diagnoses were temporally aligned with initial dispensing of bisphosphonates and the rates of new cases were calculated for 1-month and 6-month time intervals.


RESULTS
There were 7.9 new cases of uveitis/scleritis per 10,000 individuals with a newly dispensed bisphosphonate that occurred within 180 days. The relative risk of uveitis/scleritis for 6 months was 1.23 (95% confidence interval: 0.85-1.79) compared to veterans not exposed to the medications. The rates of uveitis/scleritis did not differ significantly based on route of administration (oral or parenteral) or after age adjustment. Just over a third of the diagnoses were scleritis. Nearly 43% of patients with uveitis/scleritis after bisphosphonate use had a systemic diagnosis commonly associated with inflammation of the uveal tract or sclera.


CONCLUSIONS
The 30-day and 6-month rates of uveitis/scleritis following the dispensing of a bisphosphonate drug are low and do not differ significantly from rates recorded for veterans not dispensed these drugs.
VISN-8 Patient Safety Center of Inquiry, James A. Haley Hospital, Tampa, FL 33613, USA. Dustin.French@va.gov
Dustin D
DD
French
Curtis E
CE
Margo
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000009:adverse effects*; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D016208:Databases, Factual; D004164:Diphosphonates / Q000009:adverse effects*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D000077268:Pamidronate; D010607:Pharmacy Service, Hospital / Q000706:statistics & numerical data; D011358:Product Surveillance, Postmarketing / Q000706:statistics & numerical data*; D015423:Scleritis / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014605:Uveitis / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D000077268:Pamidronate; D019386:Alendronate