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.
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.
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.
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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Liu D, Ahmet A, Ward L, Krishnamoorthy P, Mandelcorn ED, Leigh R, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy, Asthma Clin Immunol. 2013. https://doi.org/10.1186/1710-1492-9-30.
Wei L, MacDonald TM, Walker BR. Taking glucocorticoids by prescription is associated with subsequent cardiovascular disease. Ann Intern Med. 2004. https://doi.org/10.7326/0003-4819-141-10-200411160-00007.
Kremer JM. The CORRONA database. Autoimmun Rev. 2006. https://doi.org/10.1016/j.autrev.2005.07.006.
Jabs DA, Rosenbaum JT, Foster CS, et al. Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: Recommendations of an expert panel. Am J Ophthalmol. 2000. https://doi.org/10.1016/S0002-9394(00)00659-0.
Dick AD, Rosenbaum JT, Al-Dhibi HA, et al. Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis: Fundamentals Of Care for UveitiS (FOCUS) Initiative. Ophthalmology. 2018. https://doi.org/10.1016/j.ophtha.2017.11.017.
Hoes JN, Jacobs JWG, Boers M, et al. EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis. 2007. https://doi.org/10.1136/ard.2007.072157.
Lamb CA, Kennedy NA, Raine T, et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019. https://doi.org/10.1136/gutjnl-2019-318484.
Uveitisstudygroup.org. 2018. Uveitis National Clinical Study Group. http://www.uveitisstudygroup.org/.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009. https://doi.org/10.1016/j.jbi.2008.08.010.
Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019. https://doi.org/10.1016/j.jbi.2019.103208.
R Development Core Team 3.0.1. A language and environment for statistical computing. R Found. Stat. Comput. 2013.
Rothova A. Corticosteroids in uveitis. Ophthalmol Clin North Am. 2002. https://doi.org/10.1016/S0896-1549(02)00023-8.
Jones NP, Anderton LC, Cheong FM, Whallet A, Stanford MR, Murray PI, et al. Corticosteroid-induced osteoporosis in patients with uveitis. Eye. 2002. https://doi.org/10.1038/sj.eye.6700163.
Nguyen QD, Hatef E, Kayen B, MacAhilig CP, Ibrahim M, Wang J, et al. A Cross-sectional study of the current treatment patterns in noninfectious uveitis among specialists in the United States. Ophthalmology. 2011. https://doi.org/10.1016/j.ophtha.2010.03.029.
Nguyen QD, Merrill PT, Jaffe GJ, et al. Adalimumab for prevention of uveitic flare in patients with inactive non-infectious uveitis controlled by corticosteroids (VISUAL II): a multicentre, double-masked, randomised, placebo-controlled phase 3 trial. Lancet. 2016. https://doi.org/10.1016/S0140-6736(16)31339-3.
Dick AD, Tundia N, Sorg R, Zhao C, Chao J, Joshi A, et al. Risk of ocular complications in patients with noninfectious intermediate uveitis, posterior uveitis, or panuveitis. Ophthalmology. 2016. https://doi.org/10.1016/j.ophtha.2015.10.028.
Dr Timothy Raine, Addenbrooke’s Hospital, The Uveitis National Clinical Study Group.
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
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.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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