Rheumatologists and Ophthalmologists Differ in Treatment Decisions for Ocular Behçet Disease

Palestine, Alan G.; Kolfenbach, Jason R.; Ozzello, Daniel J.

doi:10.1097/rhu.0000000000000424

Cited by 9 publications

(5 citation statements)

References 14 publications

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“…First U.S. patients seen by rheumatologists may have more joint complaints, as has been described in other studies [ 7 , 13 ], and biologics would be well-suited for these symptoms. Second, insurance systems are likely different between the U.S. and Eastern countries, which may make biologic medications more accessible in the U.S. Rheumatologists preferred the choice of anti-TNFi therapy over conventional DMARDs for BD when cost and prior authorization issue were not a concern [ 29 ]. Third, U.S. primary care physicians may not be as familiar with this rare disease; thus, only the most complicated patients may be diagnosed and treated by rheumatologists.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and treatment of Behçet’s disease in the USA: insights from the Rheumatology Informatics System for Effectiveness (RISE) Registry with a comparison with other published cohorts from endemic regions

Hammam

Evans

et al. 2021

Arthritis Res Ther

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Background Behçet’s disease (BD), a chronic systemic vasculitis, has distinct geographical and ethnic variation. Data regarding the epidemiology of patients with BD in the U.S. are limited; therefore, we sought to describe BD patient characteristics and medication use in the U.S., and compared them with data from patients from endemic regions. Methods We conducted a cross-sectional study using data from the RISE registry (2014–2018). Patients aged ≥ 18 years with BD were included. Sociodemographic and treatment information was extracted. We compared patients from the RISE registry to data from other published studies of patients with BD from endemic areas. Results One thousand three hundred twenty-three subjects with BD from the RISE registry were included. Mean age was 48.7 ± 16.3 years, female to male ratio was 3.8:1, and 66.7% were White. The most frequently used medications included glucocorticoids (67.6%) and colchicine (55.0%). Infliximab and adalimumab were the most used biologics (14.5% and 14.1%, respectively); 3.2% of patients used apremilast. The RISE registry had more women (79.3%), and patients were older compared to previously published BD studies from endemic areas. Methotrexate and TNFi were more commonly reported in RISE (21.8% and 29.4%) compared to studies from Egypt and Turkey. Colchicine, cyclosporine, and cyclophosphamide were more commonly used in cohorts from Egypt, Turkey, and Iran. Conclusions Findings from the largest BD dataset in the U.S. suggest that BD patients are predominantly female. Further research is needed to explore the reasons for the higher prevalence of BD among women in the U.S. and its possible impact on disease severity and management.

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Section: Discussionmentioning

confidence: 99%

Epidemiology and treatment of Behçet’s disease in the USA: insights from the Rheumatology Informatics System for Effectiveness (RISE) Registry with a comparison with other published cohorts from endemic regions

Hammam

Evans

et al. 2021

Arthritis Res Ther

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“…In addition, previous studies have shown that ophthalmologists and rheumatologists may have different preferences, based on costs, sub‐specialization and hospital authorization. All these factors emphasize the complexity of therapeutic decision‐making in these patients and the importance of combining expertise (Ozzello et al 2016; Palestine et al 2016). The current study included many patients in reproductive age, whose possible desire to have children in the near future had to be taken into account.…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary management of auto‐immune ocular diseases in adult patients by ophthalmologists and rheumatologists

Bentum

Berg

Wolf

et al. 2020

Acta Ophthalmologica

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Purpose Management of chronic vision threatening auto‐immune ocular diseases (AIOD, e.g. uveitis, scleritis) can be challenging. Guidelines recommend a multidisciplinary approach (MDA) with ophthalmologists and rheumatologists, to enhance the recognition of systemic diseases and guide the use of immunosuppressives. However, the indications and results of such an approach have not yet been studied. Methods A monocentre, retrospective chart review of all patients treated in a MDA between ophthalmologists and rheumatologists, in a Dutch tertiary center. The collaboration was twofold: a combined multidisciplinary team meeting every 2 weeks, and an ophthalmology‐dedicated rheumatology outpatient clinic. Primary endpoints of this descriptive study were as follows: indications for MDA, new diagnoses of systemic auto‐immune diseases and changes in systemic immunosuppression and prednisone dosages. Results In total, 157 adults (mean age 46 years, 57% female, median disease duration 19 months) were included, mainly with uveitis (74%) and scleritis (12%). Multidisciplinary approach (MDA)‐indications included diagnostic workup (32%), treatment support (44%), diagnostic‐and‐treatment support (10%) and side effects (8%). A systemic disease was newly diagnosed in eight and already present in 34 patients. At baseline, 54 patients used oral prednisone at >7.5 mg/day. Non‐corticoid immunosuppressives, mostly methotrexate, were started in 41% of the patients. During follow‐up, systemic prednisone was lowered to ≤7.5 mg/day in 68% of the patients. Conclusion This evaluation of an MDA‐programme in the management of AIOD demonstrated its added value. Mainly, it addressed the high demand for support in managing systemic immunosuppression, resulting in significant corticosteroid tapering. In addition, it resulted in the recognition of underlying systemic diseases.

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“…This study specifically looked at adherence barriers in a sample of pediatric patients. The literature on medication selection by the treating physician based on cost has disparate conclusions depending on the anatomic location of uveitis being treated, which ranges from no effect to strictly choosing therapy based on price [10][11][12]. Understanding that there are financial constraints to treatment and adherence in patients with uveitis is only half of the problem.…”

Section: Introductionmentioning

confidence: 99%

Analyzing the demographics of patients with uveitis in an indigent, urban population

et al. 2023

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Purpose To study the types of uveitis examined in a hospital serving indigent populations in need of low-cost care. Methods A retrospective chart review examined the electronic medical records of all patients with uveitis-related at Drexel Eye Physicians. Data collected included demographics, anatomic location of the uveitis, systemic disease associations, treatment modalities and insurance. Statistical analysis was performed using χ² or Fischer exact tests. Results 270 patients (366 eyes) were included for analysis, 67% of patients identified as African American. Most eyes (95.3%, N = 349) were treated with topical corticosteroid drops, and only 6 (1.6%) received an intravitreal implant. Immunosuppressive medications were started in 24 patients (8.9%). Nearly 80% depended to some extent on Medicare or Medicaid Assistance for treatment coverage. There was no association between insurance type and use of biologics or difluprednate. Conclusion We found no association between insurance type and the prescription of medications for uveitis that should be used at home. There was a minimal number of patients prescribed medications for implantation in the office. The adherence of use of medications at home should be investigated.

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Rheumatologists and Ophthalmologists Differ in Treatment Decisions for Ocular Behçet Disease

Abstract: Physician decision making is influenced by medical specialty and concerns regarding cost and prior authorization.

Cited by 9 publications

References 14 publications

Epidemiology and treatment of Behçet’s disease in the USA: insights from the Rheumatology Informatics System for Effectiveness (RISE) Registry with a comparison with other published cohorts from endemic regions

Epidemiology and treatment of Behçet’s disease in the USA: insights from the Rheumatology Informatics System for Effectiveness (RISE) Registry with a comparison with other published cohorts from endemic regions

Multidisciplinary management of auto‐immune ocular diseases in adult patients by ophthalmologists and rheumatologists

Analyzing the demographics of patients with uveitis in an indigent, urban population

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