Systemic corticosteroid use continues in some patients with CSC despite risks
Click Here to Manage Email Alerts
Patients with central serous chorioretinopathy may be prescribed systemic corticosteroids despite evidence showing that steroids can contribute to the disease, according to data published in Ophthalmology.
In a retrospective analysis, Amee D. Azad, MD, MS, and colleagues investigated the frequency of systemic corticosteroid prescriptions before and after diagnosis of central serous chorioretinopathy (CSC) through a U.S. claims database.
The study included 3,418 patients with CSC from all regions of the U.S. and 17,178 subjects without CSC matched for age, sex, general health and geographic region. All subjects received care from 2007 to 2015.
The researchers compared systemic corticosteroid prescriptions before and after CSC diagnosis as well as the prescribing patterns between optometrists and ophthalmologists. In addition, they determined likelihood of steroid treatment in patients with CSC vs. control subjects.
Almost 39% of patients with CSC were prescribed systemic steroids at some point during the analysis period compared with 23% of the control subjects. Patients with CSC were significantly less likely to be prescribed steroids within 6 months after diagnosis compared with patients without CSC. However, patients with CSC were significantly more likely to be prescribed steroids by 2 years after diagnosis.
Prescribing patterns were similar between regions, as well as between ophthalmologists and optometrists.
“Despite evidence showing that steroids contribute to CSC development, many patients continue to be prescribed systemic corticosteroids after CSC diagnosis,” Azad and colleagues wrote. “Our results suggest a need for greater communication and collaboration among providers to ensure that clinical practice reflects evidence-based recommendations.”
The authors encouraged more work to identify prescribers, indications and alternative therapies and determine the impact of steroids on visual function, CSC duration and recurrence.
“A need for greater communication and collaboration with non-eye care providers exists to enhance adherence to evidence-based recommendations for CSC management,” they added.
Perspective
Back to Top
Studies have evaluated how long it takes for clinical research to translate to clinical practice. The number that generally gets kicked around is 17 years.
The first cases associating steroid use to CSC began to appear in the late 1980s to mid 1990s. By the early 2000s, a preponderance of evidence supported not using steroids to treat patients with CSC and discontinuing use for patients on them. This study looks at health claims data from 2007 to 2015 to evaluate “had the message gotten through.”
The authors evaluated employer-based insurance claims to find new cases of CSC diagnosed by optometrists and ophthalmologists and their relationship to steroid prescriptions before and after diagnosis. These prescriptions for steroids were for systemics, not topicals. Not an insignificant number (12%) of these newly diagnosed patients had a history of steroid use in the prior year. Most cases were diagnosed by ophthalmologists, but those ODs who did diagnose CSC kept the patients in their offices (97%). The results showed that optometry patients were no more likely to have received a steroid prescription than ophthalmology patients after diagnosis. Importantly, by 24 months after CSC diagnosis, 20% had received new steroid prescriptions. The overwhelming bulk of these were likely not for CSC but to treat unrelated systemic conditions. Informing other providers that steroids should be avoided in patients with CSC is key.
Collapse
Read more about
Click Here to Manage Email Alerts