Abstract
Purpose :
Uveitis contributes to an estimated 10-15% of all blindness cases in the United States. Prompt diagnosis and treatment with immunosuppressive medications are crucial in preventing long-term complications in noninfectious uveitis (NIU). This study aims to assess the real-world prescribing patterns of corticosteroid-sparing treatments among uveitis specialists in the United States.
Methods :
We analyzed Medicare Part D prescription data from 2013 to 2021 and cross-referenced it with unique identifiers of uveitis specialists. To identify US-based uveitis specialists, we utilized the American Uveitis Society (AUS) and the Ocular Immunology and Uveitis Foundation (OIUF) member directories. We analyzed the prescribing patterns and associated costs for the most commonly prescribed immunomodulatory treatments (IMTs), including methotrexate, mycophenolate mofetil, azathioprine, adalimumab, and other less commonly prescribed medications.
Results :
We included data on 158 (43% female) uveitis specialists who prescribed medications for 593,211 Medicare beneficiaries. IMTs accounted for 3.9% (60,973) of their total prescriptions. The timeframe from 2013 to 2021 demonstrated a significant growth in IMT prescriptions, increasing from 4,115 (3%) to 10,701 (5.1% of all drugs, p<0.001). Notably, during the COVID-19 pandemic in 2020-2021, there was an 11% increase in IMT prescriptions. Over the study period, prescriptions for methotrexate (-0.65, p=0.049), mycophenolate mofetil (-1.55, p<0.001), and azathioprine (-0.28, p=0.02) declined. In contrast, utilization of adalimumab markedly increased from 0.93% in 2013 to 18.5% of IMT prescriptions in 2021, particularly after receiving FDA approval in 2016 (4.81, p=0.002). Adalimumab emerged as the most expensive IMT, averaging $6,683/prescription and constituting 73.5% of the total IMT expenditure. Average costs for other drugs ranged from $52 (methotrexate) to $148.3 (mycophenolate mofetil). During the study period, adalimumab costs increased significantly (571.55, p<0.001), while methotrexate costs declined (-3.3, p=0.003).
Conclusions :
The preferences of uveitis specialists in managing NIU can be influenced by several factors, such as drug efficacy, FDA approvals, costs, and insurance considerations. Effective management necessitates an ongoing evaluation of treatment patterns and cost-effectiveness.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.