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Tasanee Braithwaite, Jason Delisser, Jonathan Virgo, Edward Hindle, William Tucker, Harry Petruskin, Angela L Rees, Dhanes Thomas, Mark C Westcott, Peter Addison, Carlos Pavesio, Richard W J Lee, Alastair K Denniston, Narciss Okhravi; Oral immunosuppression practice for inflammatory eye disease: A one-year analysis of prescriptions at Moorfields Eye Hospital. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3527. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
The need for oral immunosuppression indicates sight-threatening or otherwise severe inflammatory disease. Our first aim was to determine the prevalence of oral systemic immunosuppressive use in the largest tertiary referral centre for ophthalmology in the UK. Our second aim was to explore the extent to which prescription of prednisolone, and different second-line agents, varies by clinical service.
Anonymized pharmacy data including prescription date, service, drug, dose and an identification number was exported from the Electronic Pharmacy Record for all prescriptions issued at Moorfields Eye Hospital, City Road, London, between 1 July 2016 and 30 June 2017. Statistical analyses were performed using standard statistical software (StataCorp. 2013. Stata Statistical Software: Release 13.1).
Moorfields recorded 309,685 visits by 165,451 patients across all outpatient services in this 12-month period, with an additional 101,883 A&E attendances by 80,33 patients. Overall, the prevalence of patients receiving oral immunosuppression was 1.52% in ten clinical services (1740/114,254 patients), and 11.5% in the uveitis service (665/5769 patients) (See Table 1). The most frequently prescribed agent was prednisolone (65.8%, 5400 prescriptions), followed by mycophenolate mofetil (MMF) (19.4%, 1595 prescriptions), methotrexate (MTX) (5.5%, 472 prescriptions), tacrolimus (5.1%, 415 prescriptions), ciclosporin (2.2 %, 183 prescriptions), and azathioprine (AZA) (2.1 %, 173 prescriptions). The proportion of prescriptions for prednisolone ranged from 92.2 % in adnexal patients, to 46.7% in cornea/external eye disease patients, and 46.2 % in paediatric patients. Amongst specialties prescribing immunosuppression more frequently, MMF was generally the preferred second line agent, except in neuro-ophthalmology (azathioprine preferred) and paediatrics (methotrexate preferred).
The highest prevalence of oral immunosuppression use occurs in the uveitis service, indicating that more than one in ten patients have sight-threatening inflammatory eye disease. Different services have different preferences for second-line immunosuppression, with MMF being the most frequently preferred agent.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Table 1: Prevalence of patients receiving oral immunosuppression, percentage of prescriptions for prednisolone, and preference for second-line immunosuppressive agents, by service
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