Corticosteroids May Be Overprescribed as Uveitis Treatment

More than a third of patients with uveitis had been prescribed more corticosteroids than the reference standard, researchers from the United Kingdom found in a study published in Eye. The research suggests that there’s an opportunity to reduce excess prescribing in a portion of these patients.

Systemic corticosteroids are an effective first-line therapy for treating uveitis. However, a daily oral prednisolone dose of more than 7.5 mg/day has been associated with a more than double increase in the risk of developing cardiovascular issues, according to researchers. Further, doses of more than5 mg/day are linked with bone density loss.

The Ocular Inflammation Steroid Toxicity Risk (OSTRICH) study was conducted to evaluate corticosteroid use patterns in patients with uveitis and scleritis and to determine adherence to an international consensus target of 7.5 mg/day or less of prednisolone. The team conducted a national multicenter audit of prescribing patterns at sites in the United Kingdom. High-dose corticosteroids were defined as maintenance of greater than 7.5 mg prednisolone for more than3 consecutive months, or more than 1 course of at least40 mg of oral corticosteroid or at least500 mg intravenous methylprednisolone in the past 12 months. Case notes of patients who exceeded the prescribing threshold were reviewed by an independent uveitis specialist and judged as avoidable or not based upon a scoring matrix.

The analysis revealed that 33% of patients had been prescribed excessive corticosteroids when compared with the reference standard. An analysis of the decision-making processes in these cases suggests there may be an opportunity to reduce excess prescribing in 25% of these patients, according to investigators.

Specifically, of the 667 eligible patients, 285 (42.7%) were treated with oral or IV corticosteroids in the previous 12 months. More than a third (n=96, 33.7%) exceeded the threshold for high-dose corticosteroids. In 25% of those cases, overprescribing was avoidable. More patients received immunomodulatory therapy in the group treated with corticosteroids above the threshold than below the threshold (P <.001). However, no significant difference was noted in immunomodulatory therapy doses. According to the researchers, corticosteroids may be overused to reduce the risk of vision loss in the absence of other effective therapies.

This study had several limitations, including that the 6-week period of patient enrollment may have been too short. Second, the way consecutive uveitis patients were identified varied between sites, which may have introduced bias if patients were missed. Lastly, it is possible that prescribing practices at nonspecialist centers and in other countries may differ from the findings in this study.

Reference

Leandro L, Beare N, Bhan K, et al. Systemic corticosteroid use in UK Uveitis practice: results from the ocular inflammation steroid toxicity risk (OSTRICH) study. Eye. February 2, 2021. doi:10.1038/s41433-020-01336-6