Are adverse events higher among patients with acute optic neuritis prescribed glucocorticoids? A retrospective, longitudinal cohort study.

Autor:	De Lott LB; Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA ldelott@med.umich.edu.; Neurology, University of Michigan, Ann Arbor, Michigan, USA., Brennan B; Biostatistics, University of Michigan, Ann Arbor, Michigan, USA., Wallace B; Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA., Kerber K; Neurology, The Ohio State University, Columbus, Ohio, USA., Burke JF; Neurology, The Ohio State University, Columbus, Ohio, USA., Roslin C; University of Michigan, Ann Arbor, Michigan, USA., Terman S; Neurology, University of Michigan, Ann Arbor, Michigan, USA., Andrews C; Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA., Waljee AK; Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.; Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA., Banerjee M; Biostatistics, University of Michigan, Ann Arbor, Michigan, USA.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2024 Jul 11; Vol. 14 (7), pp. e076801. Date of Electronic Publication: 2024 Jul 11.
DOI:	10.1136/bmjopen-2023-076801
Abstrakt:	Objective: Optic neuritis (ON) is an acute focal inflammation of the optic nerve routinely treated with glucocorticoids. We aimed to compare adverse events (AE) among glucocorticoid-treated and untreated patients in the real world to guide clinical decision making about treatment tradeoffs. Design: Retrospective, longitudinal cohort study. Setting: Claims study from a large, private insurer in the USA (2005-2019). Participants: Adults≥18 years old with ≥1 ICD9/10 ON diagnosis with an evaluation/management visit code, and ≥6 months continuous enrolment prior to and following ON diagnosis. Intervention: Glucocorticoid prescription exposure. Primary and Secondary Outcome Measures: Primary outcome was any AE within 90 days of glucocorticoid prescription. Secondary outcome was AE assessment by severity. Generalised estimating equations with logit link assessed relationships between glucocorticoid prescription and AEs. High-dimensional propensity score analyses accounted for potential confounding (eg, sociodemographics and comorbidities). Sensitivity analyses restricted the cohort to high-dose prescriptions (≥100 mg prednisone equivalent, injection/infusion), AEs within 30 days, highly specific ON definition and traditional propensity score match. Results: Of the 14 311 people with 17 404 ON claims, 66.3% were women (n=9481), predominantly White (78.2%; n=9940), with median age (IQR)=48 (37,60) years. Within 90 days of the claim, 15.7% (n=2733/17 404) were prescribed glucocorticoids. The median (IQR) prescription duration=10 (6,20) days. Any and severe AEs were higher among patients prescribed glucocorticoids versus none (any AEs: n=437/2733 (16.0%) vs n=1784/14 671 (12.2%), adjusted OR 1.33 (95% CI: 1.18 to 1.50); severe AEs: n=72/2733 (2.6%) vs n=273/14 671 (1.9%), adjusted OR 1.82 (95% CI: 1.37 to 2.35)). Sensitivity analyses were similar. Conclusions: Real-world glucocorticoid prescriptions among ON patients were short-term, associated with a 30% relative increase in potentially serious AEs captured within healthcare encounters, including those not previously observed, such as VTE. These results can inform treatment decisions, particularly for ON patients likely to experience only marginal benefits. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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