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

IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology science Pub Date : 2025-01-27 DOI:10.1016/j.xops.2025.100718

Evan M. Chen MD, D. Claire Miller MS, Yuwei Sun MS, Anika Kumar BA, Jason Richards MPH, Nisha R. Acharya MD

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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 Disclosure(s)

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

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2019冠状病毒病大流行对非传染性葡萄膜炎起始治疗的影响

目的2019冠状病毒病（COVID-19）大流行期间的初步研究表明，先前或同时进行免疫调节治疗（IMT）可能会增加COVID-19感染的风险和严重后果。本研究的目的是确定COVID-19大流行对非感染性葡萄膜炎治疗模式的影响。DesignRetrospective使用Optum Labs数据仓库进行中断时间序列（ITS）分析，Optum实验室数据仓库是美国一个包含行政索赔和电子健康记录数据的国家医疗保健数据库。参与者：2017年12月1日至2020年12月31日期间新诊断为NIU的个体，且在该诊断前连续入组≥1年。方法本研究分为3个时间段：大流行前（2017年12月1日- 2019年11月30日）、大流行早期（2020年3月1日- 2020年12月31日）和疫苗后（2021年1月1日- 2021年9月30日），对应于大流行前的时间、大流行期间没有COVID-19疫苗可用的时间和疫苗开始广泛使用后的时间。葡萄膜炎治疗的标准化处方率被建模为ITS。在治疗时间分析中，使用Cox比例风险模型来确定不同时间段之间不同治疗方式的可能性差异。主要结局指标：牛牛初始治疗选择的时间趋势。结果本研究纳入22 444例新诊断为NIU的患者。平均年龄61.9岁（标准差17.5），女性占59.3%。在大流行期间，局部、局部和全身皮质类固醇或免疫抑制治疗（改善疾病的抗风湿药物和生物制剂）的处方趋势没有明显的时间中断(所有P >；0.05)。总体而言，与大流行前相比，局部类固醇更有可能在早期开处方(风险比[HR] 1.10；95%置信区间[CI] 1.06-1.15；P & lt;0.001)。眼内类固醇在早期也有较多的使用(HR 1.29；95% ci 1.13-1.46；P & lt;0.001)和疫苗接种后(HR 1.29；95% ci 1.14-1.46；P & lt;0.001)。与大流行前相比，疫苗接种后imt的使用有所增加(HR 1.25；95% ci 1.07-1.46；P & lt;0.001)。结论不同流行时期牛牛的处方模式无显著差异。然而，与大流行前相比，局部和局部类固醇治疗NIU的早期总体上有所增加。财务披露作者在本文中讨论的任何材料中没有专有或商业利益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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