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. 2021 Dec;35(12):3342-3349.
doi: 10.1038/s41433-020-01336-6. Epub 2021 Feb 2.

Systemic corticosteroid use in UK Uveitis practice: results from the ocular inflammation steroid toxicity risk (OSTRICH) study

Lorna Leandro  1 , Nicholas Beare  2 , Kanchan Bhan  3 , Philip I Murray  4 , Colm Andrews  5 , Erika Damato  6 , Alastair K Denniston  7 , Nitin Gupta  8 , Periyasamy Kumar  9 , Archana Pradeep  10 , Fahd Quhill  11 , Adam Ross  12 , Amira Stylianides  2 , Srilakshmi M Sharma  13 ; Uveitis National Clinical Study Group
Collaborators, Affiliations

Systemic corticosteroid use in UK Uveitis practice: results from the ocular inflammation steroid toxicity risk (OSTRICH) study

Lorna Leandro et al. Eye (Lond). 2021 Dec.

Abstract

Objectives: To ascertain adherence to an international consensus target of ≤7.5 mg/day of prednisolone for maintenance systemic corticosteroid (CS) prescribing in uveitis and report the frequency of courses of high-dose systemic CS in the UK.

Methods: We conducted a national, multicentre audit of systemic CS prescribing for uveitis at 11 UK sites between November 2018 and March 2019. High-dose CS was defined as (1) maintenance >7.5 mg prednisolone for >3 consecutive months, or (2) >1 course ≥40 mg oral CS or ≥500 mg intravenous (IV) methylprednisolone in the past 12 months. Case notes of patients exceeding threshold CS doses were reviewed by an independent uveitis specialist and judged as avoidable or not, based upon a scoring matrix.

Results: Of 667 eligible patients, 285 (42.7%) were treated with oral or IV CS over the preceding 12 months; 96 (33.7%) of these exceeded the threshold for high-dose CS. Twenty-five percent of prescribing in patients on excess CS was judged avoidable; attributed to either prescribing long-term CS without evidence of consideration of alternative strategies, prescribing error or miscommunication. More patients received immunomodulatory therapy (IMT) in the group treated with CS above threshold than below threshold (p < 0.001) but there was no significant difference in doses of IMT.

Conclusion: 33% of patients had been prescribed excessive corticosteroid when compared to the reference standard. An analysis of decision-making suggests there may be opportunity to reduce excess CS prescribing in 25% of these patients.

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Conflict of interest statement

SMS: Paid advisory boards for Alimera Sciences, Gilead, Abbvie and Allergan; NB: paid advisory boards for Alimera Sciences and Gilead. NB’s institution has received funds from Allergan.

Figures

Fig. 1
Fig. 1. Study Diagram for Phase 1 and Phase 2 (CS corticosteroid, IMT immunomodulatory therapy).
11 centres participated in Phase 1 where data from 692 patients were included in analysis. 5 centres participated in Phase 2 where the clinical record for 52 cases were assessed to determine whether there was avoidable or unavoidable excess corticosteroid prescribing. Case records from centres who did not participate in Phase 2 is marked as ʻmissing dataʼ. CS systemic corticosteroid, IMT Immunomodulatory Therapy.
Fig. 2
Fig. 2
Distribution of corticosteroid use over 12 months.
See this image and copyright information in PMC

Comment in

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