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Tytuł pozycji:

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

Tytuł :
Systemic corticosteroid use in UK Uveitis practice: results from the ocular inflammation steroid toxicity risk (OSTRICH) study.
Autorzy :
Leandro L; University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
Beare N; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
Bhan K; The Leeds Centre for Ophthalmology, Leeds, UK.
Murray PI; University of Birmingham, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
Andrews C; Oxford Eye Hospital, Oxford, UK.
Damato E; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Denniston AK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Gupta N; West Suffolk NHS Foundation Trust, Bury St Edmunds, UK.
Kumar P; University Hospitals of Leicester NHS Trust, Leicester, UK.
Pradeep A; Nottingham University Hospitals NHS Trust, Nottingham, UK.
Quhill F; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England.
Ross A; Bristol Eye Hospital, Bristol, England.
Stylianides A; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
Sharma SM; Oxford Eye Hospital, Oxford University Hospitals NHS Trust, Oxford, England. .
Pokaż więcej
Corporate Authors :
Uveitis National Clinical Study Group
Źródło :
Eye (London, England) [Eye (Lond)] 2021 Feb 02. Date of Electronic Publication: 2021 Feb 02.
Publication Model :
Ahead of Print
Typ publikacji :
Journal Article
Język :
English
Imprint Name(s) :
Publication: <2003->: London : Nature Publishing Group
Original Publication: [London : Ophthalmological Society of the United Kingdom, 1987-
References :
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Dick AD, Rosenbaum JT, Al-Dhibi HA, et al. Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis: Fundamentals Of Care for UveitiS (FOCUS) Initiative. Ophthalmology. 2018. https://doi.org/10.1016/j.ophtha.2017.11.017 .
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Uveitisstudygroup.org. 2018. Uveitis National Clinical Study Group. http://www.uveitisstudygroup.org/ .
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Nguyen QD, Hatef E, Kayen B, MacAhilig CP, Ibrahim M, Wang J, et al. A Cross-sectional study of the current treatment patterns in noninfectious uveitis among specialists in the United States. Ophthalmology. 2011. https://doi.org/10.1016/j.ophtha.2010.03.029 . (PMID: 10.1016/j.ophtha.2010.03.02921640258)
Nguyen QD, Merrill PT, Jaffe GJ, et al. Adalimumab for prevention of uveitic flare in patients with inactive non-infectious uveitis controlled by corticosteroids (VISUAL II): a multicentre, double-masked, randomised, placebo-controlled phase 3 trial. Lancet. 2016. https://doi.org/10.1016/S0140-6736(16)31339-3 .
Dick AD, Tundia N, Sorg R, Zhao C, Chao J, Joshi A, et al. Risk of ocular complications in patients with noninfectious intermediate uveitis, posterior uveitis, or panuveitis. Ophthalmology. 2016. https://doi.org/10.1016/j.ophtha.2015.10.028 .
Grant Information :
MR/N011775/1 United Kingdom MRC_ Medical Research Council
Contributed Indexing :
Investigator: T Braithwaite; A Price; C Arthur
Entry Date(s) :
Date Created: 20210203 Latest Revision: 20210317
Update Code :
20210623
DOI :
10.1038/s41433-020-01336-6
PMID :
33531696
Czasopismo naukowe
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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