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Nandini Venkateswaran, Melissa Daluvoy, S. Grace Prakalapakorn, Shannon Blalock, Terry Kim; Treatment Patterns for Pediatric Vernal Keratoconjunctivitis Within the First Year of Diagnosis in the United States. Invest. Ophthalmol. Vis. Sci. 2020;61(7):2948.
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Vernal keratoconjunctivitis (VKC) is a chronic allergic inflammatory disease of the ocular surface occurring predominantly in children that can be sight-threatening when severe. Minimal published literature exists on VKC treatment patterns in the United States (US), especially from those with more severe forms. We conducted an analysis of a healthcare claims database to characterize how VKC is initially treated in the US.
The IQVIA Health Plan Claims Data database is one of the largest, closed, healthcare claims databases in the US, including fully adjudicated medical and pharmacy claims for >115 million enrollees. All patients 0-18 years of age with at least one International Classification of Diseases (ICD) 9 or ICD10 code for VKC from 2007-2017 were included. Patients must have filled a prescription reasonably inferred to be for VKC from an eyecare professional within 21 days of their initial diagnosis.
Of 1013 newly diagnosed patients with a VKC-specific medication claim, 81% were prescribed corticosteroids (CST), 11% antihistamines/mast cell stabilizers, 7% were treated with an antibiotic alone, and 1% received an immunomodulator. Nearly all (92%) were treated with topical medications. Of the 821 patients prescribed CST, 95% received topical formulations, 2% systemic therapy and 3% received both. Because there are no distinct diagnosis codes for severity of VKC, the potency of the initial therapy selected was used as a surrogate marker to identify disease severity. Of the initial cohort of 1013 patients, 82% were categorized as having moderate to severe VKC based on treatment with CST or immunomodulators. Of those receiving only topical CST, the average initial treatment duration was 6.3 weeks.
To the best of our knowledge, this represents the only detailed analysis of VKC treatment patterns in the US. A critical finding is topical CSTs are the mainstay of treatment for managing newly diagnosed VKC. Using initial therapy prescribed as a surrogate for disease severity, we estimate that >80% of pediatric patients likely have moderate to severe forms of disease upon diagnosis. Notably, CSTs can have short and long-term side effects in the pediatric population and antibiotic monotherapy is of concern given its overall inefficacy in treating VKC. Evaluation of treatment patterns can help clinicians better tailor therapy for their VKC patients.
This is a 2020 ARVO Annual Meeting abstract.
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