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E. Hatef Naimi, C. Macahilig, B. Kayen, Q. D. Nguyen; Understanding Treatment Guidelines in Uveitis: A Cross-Sectional Study of the Current Treatment Patterns of Non-Infectious Anterior, Intermediate, Posterior, and Pan-Uveitis Among Specialists in the United States. Invest. Ophthalmol. Vis. Sci. 2009;50(13):287.
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Corticosteroids (CS) is the only approved drug class for treatment of non-infectious uveitis. To decrease risks of serious side-effects associated with chronic use of systemic CS, guidelines for employment of immunosuppressive drugs have recommended use of steroid-sparing agent if control cannot be achieved with ≤ 10 mg of prednisone or its equivalence administered daily. The present study evaluates current treatment patterns among physicians who manage patients with non-infectious anterior, intermediate, posterior, and pan-uveitis.
A cross-sectional, multi-center study was conducted across the United States to survey 60 ophthalmologists and 3 rheumatologists from 27 states using ICD-9 codes. Clinical and demographic data related to patients with different types of uveitis was reported by these physicians through standardized pre-designed questionnaire. The physicians were also asked if they were aware of or used recommended guidelines in treating uveitis.
34 (54%) surveyed physicians self-reported having a sub-specialty training. Each physician managed a mean of 5,500 patients of various diseases; approximately 5% of each physician’s practice were patients with uveitis requiring systemic CS treatment. Among these patients with uveitis, 580 were randomly selected for this study. Anterior uveitis was diagnosed in 168 (29%) patients; intermediate: 140 (24%); posterior: 150 (26%); and pan-uveitis: 122 (21%) patients. 199 (34%) had active disease. Mean time interval from diagnosis of uveitis to time of survey was 3.1 to 4.5 years. A systemic disorder was associated with uveitis in 16% to 54% of subjects. 57% to 100% of patients received systemic immunosuppressive therapy while 61% to 88% received combination therapy. 358 of 580 subjects (61%) received systemic CS with a mean initial daily dose of 44mg, tapered to 34mg prednisone or equivalent as the maintenance dose. Among physicians surveyed, 75% did not use/were not aware of treatment guidelines for uveitis.
The present study reveals that the majority of physicians surveyed who care for patients with uveitis are not familiar with or do not adhere to current recommended guidelines for the management of uveitis. High CS doses used to maintain control of disease and low level of awareness of therapeutic guidelines suggest that further emphasis on educating the medical community and reinforcing treatment guidelines is needed to improve the care of patients with uveitis.
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