Awareness of uveitis clinical treatment guidelines remains a problem

While corticosteroids are the only FDA-approved agent for treating uveitis, chronic use may cause undesirable toxicity. Known systemic side effects of chronic corticosteroid use can include weight gain, hypertension, development of diabetes, cardiovascular events, glaucoma, and cataract, particularly if treatment lasts six months or longer at a dose of 7.5 mg or greater.

To decrease the risk of serious side effects associated with systemic long-term corticosteroid therapy, the Standardization of Uveitis Nomenclature Working Group recommends use of steroid-sparing agents if control of uveitis cannot be achieved with ≤10 mg/day of prednisone (or equivalent) within three months.

This study investigates the degree to which these guidelines are understood and followed by physicians who routinely mangage patients with noninfectious uveitis. They interviewed a randomly selected cross-section of 60 ophthalmologists and three rheumatologists, all of whom routinely manage patients with uveitis. Half of the ophthalmologists had formal training in uveitis or retina. They also analyzed data from 580 randomly selected patients of these practitioners who had noninfectious uveitis, 360 of which were treated with systemic corticosteroids.

They found that 75 percent of providers either did not use or were unaware of recommended treatment guidelines for uveitis. As a result, patients were maintained on systemic corticosteroids regimens that exceed recommended treatment guidelines both in terms of dosage and duration. The average starting dose of corticosteroids was equivalent to 44 mg daily oral dose, and the average reported maintenance dose was 34 mg, well exceeding the published guidelines. The mean duration of therapy was 21 months. The authors also noted that 97 percent of patients had at least one flare during the studied time period despite the presence of aggressive therapy including high-dose corticosteroids.

Among the 75 percent of physicians who did not use treatment guidelines, 85 percent had hospital outpatient or clinical/office-based practices and 15 percent were affiliated with tertiary eye centers. There was no statistically significant difference among responses of clinicians in private clinics and those in tertiary care centers.

The authors conclude that these findings underscore the need to increase awareness about the serious long-term side effects of systemic steroids as well as the benefit of transitioning patients to immunomodulatory therapies as recommended.