Systemic corticosteroid use in uveitis practice: Results from the ocular inflammation steroid toxicity risk (OSTRICH) study

Objectives – To ascertain adherence to a target of systemic corticosteroid (CS) prescribing in uveitis (maintenance dose ≤7.5mg/day for <3 months) and report the frequency with which courses of high dose systemic CS are prescribed. Methods – A national multicentre audit was conducted at 11 sites within the UK. CS prescribing data for patients attending uveitis clinics for a 6-week period between November and March 2019 were collected. Excess CS was defined as (1) maintenance dose >7.5mg prednisolone for >3 consecutive months, or (2) >1 course of either ≥40mg oral or ≥ 500mg IV methylprednisolone in the past year. Case notes of patients exceeding the 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 CS over the preceding 12 months, and, of these, 96 (33.7%) exceeded the threshold dose for CS prescribing. 22% of prescribing in patients on excess CS was judged to be avoidable, mostly attributable to the prescription of long-term CS without evidence of consideration of appropriate alternative strategies. More patients received IMT in the group treated with excess CS than that treated below excess dose (p=0.015) but there was no significant difference in the doses of IMT.

Conclusion – One-third of patients requiring systemic CS were prescribed excess CS based upon a consensus target. An assessment of clinical decision–making suggests that there may be opportunity to reduce excess CS prescribing in a proportion of cases.

Author(s): Lorna Leandro                                                                                                                                                                

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