A new study published in the journal Eye suggests that one-third of patients with uveitis in the UK receive excess systemic corticosteroids (CS), and there is a scope to reduce excess prescribing in a quarter of them.
CS are widely prescribed for the treatment of uveitis and scleritis, but have been linked to poor tolerability and substantial long-term morbidity in patients.
Investigators of the Ocular Inflammation Steroid Toxicity Risk (OSTRICH) study conducted an audit of systemic CS prescribing for uveitis at 11 sites in the UK between November 2018 and March 2019. High-dose CS refers to maintenance >7.5 mg prednisolone for more than three consecutive months; alternatively, more than one course of ≥40 mg oral CS or ≥500 mg intravenous methylprednisolone in the past 12 months.
42.7 per cent of eligible patients were treated with oral or intravenous CS over the past 12 months, 33.7 per cent of whom exceeded the threshold for high-dose CS. Among those prescribed excess CS, 25 per cent of the cases were deemed avoidable and were attributed to either long-term prescribing without considering the evidence for alternative strategies, prescribing error or miscommunication. Furthermore, 68.8 per cent of patients prescribed excess CS also received immunomodulatory therapy in the past 12 months.
"Uveitis remains an area of unmet medical need, where CS may be over-utilised as a means of reducing the risk of sight loss in the absence of a sufficient range of effective therapies," the authors stated. They call for a reduction in CS exposure and also recommend modifying the current guidelines to restrict the use of high-dose CS to a maximum of one course per year.
