Impact of the Coronavirus Disease 2019 Pandemic on Initiation Therapy for Noninfectious Uveitis

Abstract

Purpose: Initial studies during the coronavirus disease 2019 (COVID-19) pandemic demonstrated a possible increased risk of COVID-19 infection and severe outcomes with prior or concurrent immunomodulatory therapy (IMT). The purpose of this study was to determine the impact of the COVID-19 pandemic on treatment patterns for noninfectious uveitis (NIU).

Design: Retrospective interrupted time series (ITS) analysis using Optum Labs Data Warehouse, a national deidentified health care database in the United States with administrative claims and electronic health record data.

Participants: Individuals with a new diagnosis of NIU from December 1, 2017, to December 31, 2020, with continuous enrollment ≥1 year before this diagnosis.

Methods: This study was divided into 3 time periods: prepandemic (December 1, 2017-November 30, 2019), early pandemic (March 1, 2020-December 31, 2020), and postvaccine period (January 1, 2021-September 30, 2021) corresponding to time before the pandemic, during the pandemic when no COVID-19 vaccine was available, and after widespread utilization of the vaccine began. Normalized prescription rates of uveitis therapies were modeled as an ITS. In the time-to-treatment analysis, Cox proportional hazard models were used to determine differences in likelihood of different modalities between time periods.

Main outcome measures: Temporal trends in the initial therapeutic choice for NIU.

Results: This study included 22 444 patients with a new NIU diagnosis. The average age was 61.9 (standard deviation 17.5) years, and 59.3% were female. There were no significant temporal breaks in prescribing trends for topical, local, and systemic corticosteroids or immunosuppressive therapy (disease-modifying antirheumatic drugs and biologics) between pandemic periods (all P > 0.05) in ITS analysis. Overall, topical steroids were more likely to be prescribed in the early versus prepandemic period (hazard ratio [HR] 1.10; 95% confidence interval [CI] 1.06-1.15; P < 0.001). Intraocular steroids also saw greater relative use during the early (HR 1.29; 95% CI 1.13-1.46; P < 0.001) and postvaccine (HR 1.29; 95% CI 1.14-1.46; P < 0.001) period. Use of IMTs increased in the postvaccine period compared with that in the prepandemic period (HR 1.25; 95% CI 1.07-1.46; P < 0.001).

Conclusions: No significant differences in prescribing patterns for NIU were observed between pandemic periods. However, utilization of topical and local steroids for NIU was, overall, increased in the early compared with the prepandemic period.

Financial disclosures: The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Keywords: COVID-19; Inflammation; Treatment medical; Uveitis.

Figure 2

Noninfectious uveitis treatment type by time period and uveitis subgroup.

Figure 3

Temporal trends in the treatment of newly diagnosed noninfectious uveitis. COVID-19 = coronavirus disease 2019; NIU = noninfectious uveitis.