Background/Purpose: Noninfectious uveitis (NIU) is a collection of intraocular inflammatory disorders associated with significant visual impairment. Corticosteroids (CS) are typically the first-line drug therapy for NIU. Despite a general awareness that patients with long-term CS exposure can suffer from serious ocular and systemic adverse events (AEs), a clear understanding of the relationship between CS exposure and the occurrence of AEs, especially in a real-world setting, is lacking. This study estimates the associations between CS exposure and the risks of developing certain ophthalmologic-related complications and systemic AEs using a large, retrospective, administrative claims database.

Methods: This analysis used data from the Truven Health MarketScan Commercial Claims Encounters database from Q1 2011 – Q1 2016, which collects data from approximately 100 different insurance companies representing about 93 million covered lives. NIU patients were included if they were older than 18 years, had two or more CS prescription fills after an NIU diagnosis, and continuous enrollment for at least 8 months (6 months prior to first CS fill and at least 2 months after). CS exposure was captured via time-dependent cumulative treatment duration (in months), cumulative daily dose of systemic CS fills, and cumulative number of topical CS fills (including eye drops and CS injections). The outcomes of interest were time to ophthalmologic-related complications (glaucoma, blindness and cataract) and time to systemic AEs (osteoporosis, cardiac failure and infections). Multivariate Cox regression models were developed to assess the relationship of CS exposure with the risk of each outcome, controlling for baseline covariates, i.e., age, gender, various comorbidities, use of immunosuppressants and biologic therapies.

Results: Among the 56,782 patients with NIU eligible for the study, 60% were female and the average age was 56 years. The cumulative number of topical CS fills was associated with a significant increase in the risk of developing all ophthalmologic-related complications (hazard ratios [HR] of 1.10, 1.06, 1.04 for glaucoma, blindness and cataract, respectively), all p-values <0.001. The cumulative systemic CS duration was associated with a significant increase in the risk of all systemic AEs (HR of 1.03, 1.02 and 1.01 for osteoporosis, cardiac failure and infections, respectively), all p-values <0.001, while the cumulative systemic CS daily dose had no substantial impact on any outcome. Immunosuppressant therapies were associated with a significant increase in the risk of blindness (HR=1.40), cataract (HR=1.20) and osteoporosis (HR=1.47), all p-values <0.05. Biologic therapies were not associated with a significant increased risk of developing any of the outcomes.

Conclusion: Increased exposure to topical CS was associated with a significant increase in the risk of developing ophthalmologic-related complications, and longer duration of systemic CS was associated with a significant increase in the risk of CS-related AEs. These findings suggest that therapies alternative to corticosteroids could be beneficial in minimizing ophthalmologic complications and AEs among patients with NIU.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-of-corticosteroid-exposure-with-ophthalmologic-complications-and-systemic-adverse-events-in-non-infectious-uveitis-patients-using-administrative-claims-in-the-united-states/