Risk of Non-infectious Uveitis with Female Hormonal Therapy in a Large Healthcare Claims Database

Abstract

Purpose : To determine if female hormonal therapy (FHT) increases the incidence of noninfectious uveitis

Methods : A retrospective cohort study was conducted comparing women enrolled in a national insurance plan exposed to FHT and matched unexposed controls. All women prescribed an FHT were eligible. Exclusion occurred in exposed and unexposed for use of an estrogen-modifying drug or disease, prior uveitis diagnosis, having <2 years of time in plan or no prior ophthalmic exam. To account for possible differences between the exposed and unexposed cohorts, a propensity score for FHT exposure was created and inverse probability of treatment weighting (IPTW) was used. Weighted Cox proportional hazards regression modeling estimated hazard ratios (HR) for noninfectious uveitis relative to FHT exposure.
The primary outcome was incident non-infectious uveitis defined as a new diagnosis code for non-infectious uveitis followed by a second instance of a non-infectious uveitis code within 120 days. A similar, but alternative outcome was also defined based on corticosteroid prescription within 120 days of the initial uveitis diagnosis instead of a second uveitis diagnosis code. Sub-analyses were conducted for anatomic subtypes of uveitis and those aged above and below 44 years.

Results : 217,653 FHT-exposed patients were matched to 928,408 controls. After IPTW, Cox regression analysis showed no difference in hazard for uveitis in exposed relative to unexposed [HR=0.99;95% Confidence Interval (CI):0.83-1.17,P=0.87] . For the alternative uveitis definition, FHT exposed individuals had a higher hazard compared to unexposed [HR=1.21;95%CI:1.04-1.41,P=0.01]. Sub-analyses showed FHT exposed had a higher hazard for anterior uveitis (HR=1.23;95%CI:1.05-1.45,P=0.01) for the alternative outcome definition but not for the primary(HR=1.05;95%CI:0.87-1.26,P=0.62). After age stratification, FHT cohort over 45 years of age had an increased hazard for the alternative outcome definition (HR=1.23;95%CI:1.03-1.46,P=0.03). A similar HR(HR=1.22) was seen for women ≤44 years of age, but it did not reach significance(P=0.20).

Conclusions : Exposure to FHT confers a higher hazard for uveitis when defined as a diagnosis with corticosteroid treatment. Although FHT is safe in the vast majority of uveitis patients, the possibility of a small increased risk with FHT should be considered when managing patients with uveitis.

This is a 2020 ARVO Annual Meeting abstract.