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David S. Chu, Scott J. Johnson, Usha G. Mallya, Rachael A. Sorg, Mei S. Duh; Treatment Patterns and Ophthalmologic Morbidity Rates in Non-infectious Uveitis Patients with Private Insurance in the U.S. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3209.
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Describe treatment patterns and ophthalmologic morbidity rates for patients primarily on corticosteroid (CTS), immunosuppressive (IMS), and biologic (BIO) therapy for chronic non-infectious uveitis. Examining treatments and outcomes for a large sample of patients in the US would shed light on how treatments are being used.
Patients with ≥1 uveitis diagnosis (ICD-9-CM 360.x-364.x excluding infectious codes) by an ophthalmologist or ≥2 by other physicians, under age 65, with private insurance coverage during a 6 month baseline were selected from data on 80.7 million enrollees. Index dates were defined as first use of CTS, IMS, or BIO between 2003-2009. CTS patients had ≥2 10-day or ≥1 30-day scripts. Kaplan Meier analysis assessed time until switching from CTS to IMS or BIO and from IMS to BIO. Morbidity rates were monthly counts of diagnosis codes for retinal detachments (RD), glaucoma, cataracts, visual disturbances, blindness, and other visual complications during baseline and treatment periods. Wilcoxon tests assessed significance.
Average time on treatment for CTS (N=19,426), IMS (N=5,466) and BIO (N=1,694) samples were 1.79, 3.66, and 8.18 months (p<0.05 across groups). Most CTS patients (88%) were never switched to IMS or BIO, and most IMS (84%) were never switched to BIO over the entire data set. In the baseline period, IMS and BIO patients had higher rates of glaucoma, visual disturbances, blindness, and visual complications than CTS patients (p<0.05 across groups). In the study period, BIO had lower monthly rates than CTS (p<0.05) for RDs (0.001 vs. 0.015), glaucoma (0.035 vs. 0.048), cataract (0.016 vs. 0.023), blindness (0.000 vs. 0.002), and visual complications (0.007 vs. 0.012). BIO had lower rates than IMS in all categories (not significant). CTS rates of comorbidities increased in every category vs. baseline unlike IMS or BIO.
Patients treated with BIO had best ophthalmologic outcomes profile based on the data, but relatively few patients were switched from CTS or IMS to BIO. There may be underuse of BIO therapy.
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