Real-world treatment patterns for patients with non-infectious uveitis in Japan: a descriptive study using a large-scale claims database (J-CAT study)

Abstract

Purpose: Non-infectious uveitis (NIU) can arise from various inflammatory disorders and can cause vision loss. Patients with mild NIU are typically treated with corticosteroid eye drops to reduce intraocular inflammation; however, other local/systemic treatments (corticosteroids, immunosuppressants, biologics) may be required for moderate-to-severe NIU, which may cause ocular complications. Here, we investigated real-world treatment patterns for NIU in Japan.

Methods: Patients were selected from a large, Japanese insurance claims database using International Classification of Diseases, Tenth Revision codes; diagnosis of NIU was confirmed via ophthalmological examination (October 2016-October 2023). Sankey diagrams were used to describe treatment transitions. Post-treatment ocular complications, potentially related surgeries, and fundus findings associated with uveitis were determined.

Results: The majority of patients (68.7%; 37,869/55,091) were treated with corticosteroid eye drops only for mild NIU; 19.0% (10,449/55,091) were given other treatments for moderate-to-severe NIU, mostly oral corticosteroids (7,473/10,449) and posterior sub-Tenon's corticosteroid injections (1,636/10,449). In patients treated with corticosteroids orally or via sub-Tenon's injections, common transitions were to corticosteroid eye drops or censor (end of treatment/dataset or insurance withdrawal). A higher incidence of treatment-related ocular complications and potentially related surgeries (including glaucoma) was observed during the first year of NIU treatment compared with subsequent years (for moderate-to-severe NIU, estimated incidence of prescription of glaucoma drugs was 106 per 1,000 person-years [at 1 year], 73 per 1,000 person-years [at 2 years], and 52 per 1,000 person-years [at 5 years]).

Conclusion: Our comprehensive analysis of a large claims database included all prescribed medications and medical procedures (including local injections) for NIU treatment in Japan up to October 2023. Although corticosteroids are a mainstay of NIU treatment in Japan, we found that a number of treatments for moderate-to-severe NIU, other than corticosteroid eye drops, are frequently used in combination with or when switching from corticosteroid eye drops. These findings are of importance when assessing the treatment landscape and may help identify unmet clinical needs in patients with NIU.

Keywords: Corticosteroid; Glaucoma; Japan; Non-infectious uveitis; Treatment patterns.

Fig. 1

Patient attrition of eligible patients with NIU from the JMDC database. The index date, also referred to as the first encounter, is the date of the initial ophthalmological examination record (between October 1, 2016 and October 31, 2023) confirming NIU diagnosis. ICD, International Classification of Diseases, Tenth Revision; JMDC, Japan Medical Data Center; NIU, non-infectious uveitis

Fig. 2

Proportion of all eligible patients with NIU in the JMDC database receiving corticosteroid eye drops (for mild NIU), other treatments (for moderate-to-severe NIU), or no treatment for NIU. JMDC, Japan Medical Data Center; NIU, non-infectious uveitis

Fig. 3

Proportion of patients with moderate-to-severe NIU receiving treatments other than corticosteroid eye drops. Treatments taken at the first encounter (index date) and all treatments taken by the last encounter are both presented (note that patients may have received multiple treatments). Infliximab and adalimumab are TNF-α inhibitors. ADA, adalimumab; Col, colchicine; IFX, infliximab; inh, inhibitor; inj, injection; IS, immunosuppressant; IV, intravenous; IVT, intravitreal; JAK, Janus kinase; NIU, non-infectious uveitis; PDE4, phosphodiesterase-4; SCJ, subconjunctival; ST, sub-Tenon’s; TNF-α, tumor necrosis factor-alpha

Fig. 4

Treatment patterns of patients with moderate-to-severe NIU in the JMDC database. Sankey diagrams showing treatment transitions in the cohort that previously received corticosteroid eye drops and were subsequently given other treatments than corticosteroid eye drops. Only nodes of n = ≥10 are shown. CS, corticosteroid; JMDC, Japan Medical Data Center; NIU, non-infectious uveitis; Tx, treatment

Fig. 5

Treatment patterns in patients with moderate-to-severe NIU receiving systemic corticosteroids. Sankey diagrams showing treatment transitions before and after initiation of corticosteroids via (A) oral administration and (B) intravenous infusion. Only nodes of n = ≥10 are shown. Col, colchicine; CS, corticosteroid; inj, injection; IS, immunosuppressant; IV, intravenous; M0; no previous treatment; NIU, non-infectious uveitis; SCJ, subconjunctival; ST, sub-Tenon’s; TNF-α, tumor necrosis factor-alpha

Fig. 6

Treatment patterns in patients with moderate-to-severe NIU receiving local corticosteroid injections. Sankey diagrams showing treatment transitions before and after initiation of corticosteroids via (A) sub-Tenon’s injections and (B) subconjunctival injections. Only nodes of n = ≥10 are shown. Col, colchicine; CS, corticosteroid; inj, injection; IS, immunosuppressant; M0; no previous treatment; NIU, non-infectious uveitis; SCJ, subconjunctival; ST, sub-Tenon’s

Fig. 7

Treatment patterns in patients with moderate-to-severe NIU receiving TNF-α inhibitors (adalimumab or infliximab). Sankey diagram shows treatment transitions before and after initiation of TNF-α inhibitors. Only nodes of n = ≥10 are shown. Col, colchicine; CS, corticosteroid; IS, immunosuppressant; IV, intravenous; M0; no previous treatment; NIU, non-infectious uveitis; TNF-α, tumor necrosis factor-alpha

Fig. 8

Proportion of patients with moderate-to-severe NIU receiving treatments other than corticosteroid eye drops at each line. Inj, injection; IS, immunosuppressant; IV, intravenous; IVT, intravitreal; NIU, non-infectious uveitis; SCJ, subconjunctival; ST, sub-Tenon’s; TNF-α, tumor necrosis factor-alpha