A cross-sectional study of the current treatment patterns in noninfectious uveitis among specialists in the United States.
OBJECTIVE
Corticosteroids (CS) are the only approved drug class for treatment of noninfectious uveitis by the U.S. Food and Drug Administration. Serious side effects are associated with chronic use of systemic CS; established guidelines recommend the use of steroid-sparing agents if control of uveitis cannot be achieved with ≤ 10 mg/day of prednisone (or equivalent) within 3 months. This study evaluated the treatment patterns among physicians who routinely manage patients with noninfectious uveitis to determine how treatment guidelines are followed.


METHODS
Cross-sectional, multicenter study conducted across the United States.


METHODS
Sixty ophthalmologists and 3 rheumatologists were recruited using payer reimbursement International Classification of Diseases, Ninth Revision codes.


METHODS
Patient data were reported using a study-specific questionnaire. Physicians were also asked if they were aware of or used recommended treatment guidelines.


METHODS
Uveitis treatment patterns were compared with guidelines.


RESULTS
Physicians managed a mean of 5555 patients; patients with uveitis who required systemic CS treatment comprised approximately 5% of each physician's practice. A total of 580 patients with noninfectious uveitis were randomly selected for analyses. Anterior uveitis requiring systemic therapy was diagnosed in 168 patients (29%), intermediate uveitis was diagnosed in 140 patients (24%), posterior uveitis was diagnosed in 150 patients (26%), and panuveitis was diagnosed in 122 patients (21%); 199 patients (34%) had active disease. The mean time interval from the diagnosis of uveitis to the time of survey was 3.1 to 4.5 years. A systemic disorder was associated with uveitis in 16% to 54% of patients; 57% to 100% of patients received systemic immunosuppressive therapy. In all, 360 of 580 patients (62%) received systemic CS, with a mean initial daily dose of 44 mg, tapered to 34 mg prednisone (or equivalent) as maintenance dose. Among physicians surveyed, 75% did not use or were not aware of treatment guidelines for uveitis.


CONCLUSIONS
The study reveals that the majority of physicians surveyed are not familiar with or do not adhere to currently recommended guidelines for management of uveitis. High CS doses are used to maintain control of disease, and there is a low level of awareness of recommended guidelines to treat noninfectious uveitis. The finding underscores the need to place further emphasis on educating the medical community and reinforcing treatment guidelines to improve the care of patients with uveitis.
Nguyen
Quan Dong
QD
Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. qnguyen4@jhmi.edu
Hatef
Elham
E
Kayen
Brian
B
Macahilig
Cynthia P
CP
Ibrahim
Mohamed
M
Wang
Jianmin
J
Shaikh
Ovais
O
Bodaghi
Bahram
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D012219:Rheumatology; D013038:Specialization; D014481:United States; D014486:United States Food and Drug Administration; D014605:Uveitis / Q000175:diagnosis / Q000188:drug therapy*; D055815:Young Adult
D005938:Glucocorticoids; D011241:Prednisone