First Author: D.Mitkute UK
Co Author(s): C. Edelsten S. Theodoropoulou
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The argument for provision of high-cost immunomodulatory therapy [IMT] depends on demonstrating their relative efficacy to corticosteroids or low cost IMT and estimates of the size of the population that might benefit. Most reported uveitis outcomes on IMT come from referral populations which do not readily provide total population estimates of potential benefit from IMT development. We provide prescribing data and outcomes from a longstanding population-based uveitis cohort in order to estimate national unmet needs for improved IMT in uveitis.
A retrospective review of 21 years observation of a single centre semi-urban, semi-rural English uveitis clinic [7.7 million patient/years]. All IMT was prescribed by a single practitioner in this period.
The notes of all patients prescribed oral or parenteral steroids, conventional IMT or biologics were reviewed. Initial indications for prescribing, and annual treatment changes noted as well as surgical and visual outcomes.
The previously reported incidence of uveitis in this region is 147/million. The incidence of prescribing oral/parenteral steroids was 26.6/m and IMT 5.7/m. Of patients prescribed steroids, 33% continued on treatment 12 months later; 17% were prescribed IMT; 4% required IMT change; 3% were prescribed biologics. Visual outcomes were poor in those developing uveitis whilst already on IMT for systemic disease; particularly adults with inflammatory arthritis. The most frequent IMTs prescribed were azathioprine and MMF; ciclosporin and tacrolimus were also used.
Presribing patterns and drugs available for treating uveitis have changed considerably over twenty years. Early control and minimising long-term steroid use remain paramount. Review of treatment pathways suggest that the incidence of primary steroid and IMT failure is at least 1.1/million and the incidence of biologic use in those with uveitis since 2002 was 2.0/million. A policy to minimise oral steroid use and time to significant remission may result in a 2-3 fold increase in their use in the absence of more effective conventional immunosuppressants. Treatment failure of uveitis patients already taking biologics for inflammatory arthritis may be improved by appropriate biologic switching. Populations with high prevalence of Behcet's disease and other types of uveitis may have significantly different needs that require further population-based assesments.