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Systemic corticosteroid use in UK Uveitis practice: results from the ocular inflammation steroid toxicity risk (OSTRICH) study

Abstract

Objectives

To ascertain adherence to an international consensus target of ≤7.5 mg/day of prednisolone for maintenance systemic corticosteroid (CS) prescribing in uveitis and report the frequency of courses of high-dose systemic CS in the UK.

Methods

We conducted a national, multicentre audit of systemic CS prescribing for uveitis at 11 UK sites between November 2018 and March 2019. High-dose CS was defined as (1) maintenance >7.5 mg prednisolone for >3 consecutive months, or (2) >1 course ≥40 mg oral CS or ≥500 mg intravenous (IV) methylprednisolone in the past 12 months. Case notes of patients exceeding threshold CS doses were reviewed by an independent uveitis specialist and judged as avoidable or not, based upon a scoring matrix.

Results

Of 667 eligible patients, 285 (42.7%) were treated with oral or IV CS over the preceding 12 months; 96 (33.7%) of these exceeded the threshold for high-dose CS. Twenty-five percent of prescribing in patients on excess CS was judged avoidable; attributed to either prescribing long-term CS without evidence of consideration of alternative strategies, prescribing error or miscommunication. More patients received immunomodulatory therapy (IMT) in the group treated with CS above threshold than below threshold (p < 0.001) but there was no significant difference in doses of IMT.

Conclusion

33% of patients had been prescribed excessive corticosteroid when compared to the reference standard. An analysis of decision-making suggests there may be opportunity to reduce excess CS prescribing in 25% of these patients.

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Fig. 1: Study Diagram for Phase 1 and Phase 2 (CS corticosteroid, IMT immunomodulatory therapy).
Fig. 2

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Acknowledgements

Dr Timothy Raine, Addenbrooke’s Hospital, The Uveitis National Clinical Study Group.

Funding

Fight for Sight funds the Uveitis National Clinical Study Group. Dr Srilakshmi Sharma receives funding from the Medical Research Council (grant number: MR/T024682/) and the National Institute for Health Research.

Uveitis National Clinical Study Group

Lorna Leandro1, Nicholas Beare2, Kanchan Bhan3, Philip I. Murray4, Colm Andrews5, Erika Damato6, Alastair K. Denniston7, Nitin Gupta8, Periyasamy Kumar9, Archana Pradeep10, Fahd Quhill11, Adam Ross12, Amira Stylianides2, Srilakshmi M. Sharma13, Tasanee Braithwaite14, Amy Price15, Claire Arthur15

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Correspondence to Srilakshmi M. Sharma.

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Study Attribution Statement

SMS: lead author, study design, data interpretation, drafted and edited manuscript; LL: coordinated study, data analysis, contributed to the manuscript; NB: contributed to manuscript, study investigator; KB: contributed to manuscript, study investigator; PIM: manuscript review, study investigator; CA: statistical support; ED: study investigator; AKD: study investigator; NG: study investigator; PK: study investigator; AP: study investigator; FQ: study investigator; AR: study investigator; AS: study investigator.

Conflict of interest

SMS: Paid advisory boards for Alimera Sciences, Gilead, Abbvie and Allergan; NB: paid advisory boards for Alimera Sciences and Gilead. NB’s institution has received funds from Allergan.

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Members of the Uveitis National Clinical Study Group are listed below Acknowledgements.

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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 35, 3342–3349 (2021). https://doi.org/10.1038/s41433-020-01336-6

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