Systemic Corticosteroid Use after Central Serous Chorioretinopathy Diagnosis.
Systemic Corticosteroid Use after Central Serous Chorioretinopathy Diagnosis.
复制标题
中心性浆液性脉络膜视网膜病变诊断后全身使用皮质类固醇。
DOI：
10.1016/j.ophtha.2020.06.056
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发表时间：
2021
期刊：
影响因子：
13.7
通讯作者：
Pershing,Suzann
中科院分区：
文献类型：
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作者：
Azad,AmeeD;Zhou,Maggie;Afshar,ArminR;Bakri,SophieJ;Pershing,Suzann
目的分析中心性浆液性脉络膜视网膜病变 (CSC) 诊断前后全身性皮质类固醇处方的频率。设计基于回顾性索赔的分析。参与者是 2007 年至 2015 年间接受护理的商业保险受益人的全国代表性样本。方法我们将研究人群限制为由眼科护理人员诊断出患有 CSC 事件的受益人，排除那些患有其他主要眼科合并症的人。我们开发了一个与 CSC 患者按年龄、性别、一般健康状况（查尔森合并症指数）和地理区域相匹配的非 CSC 比较队列。我们比较了 CSC 诊断前后和诊断提供者（验光师与眼科医生）的全身性皮质类固醇处方，并使用 Logistic 和 Cox 比例风险回归模型评估了 CSC 与匹配对照患者之间类固醇治疗的可能性。 主要结果指标 CSC 患者在诊断前 12 个月内以及诊断后 6、12 和 24 个月内的全身性皮质类固醇处方频率，开始类固醇治疗的中位时间和CSC 患者和对照患者在诊断后停药以及接受类固醇治疗的几率。结果我们确定了 3418 名 CSC 患者。近 39% (n = 1326) 的患者在分析期间的某个时刻服用了全身类固醇，而对照组的这一比例为 23%（17 178 名患者中的 4033 名患者）。超过 12% 的 CSC 患者 (n = 430) 在诊断前 1 年内发生，近 12% (n = 404) 在诊断后 1 年内发生。大多数诊断后接受类固醇治疗的患者均未接受过类固醇治疗 (n = 231)。在接受类固醇治疗的患者中，CSC 患者表现出诊断后首次服用类固醇处方的中位时间较长（非 CSC 患者为 1.82 年 vs. 0.50 年），并且最后一次服用类固醇处方的时间较长（非 CSC 患者为 1.62 年 vs. 0.35 年）。尽管与非 CSC 患者相比，CSC 患者在诊断后 6 个月内接受类固醇治疗的可能性明显较低（比值比，0.72；95% 置信区间，0.59-0.89），但他们在诊断后 2 年内接受类固醇治疗的可能性明显更高。眼科医生与验光师诊断的患者的处方模式相似。结论尽管有证据表明类固醇有助于 CSC 的发展，但许多患者在 CSC 诊断后继续服用全身皮质类固醇。我们的结果表明，提供者之间需要加强沟通和合作，以确保临床实践反映基于证据的建议。
PurposeTo analyze the frequency of systemic corticosteroid prescriptions before and after central serous chorioretinopathy (CSC) diagnosis.DesignRetrospective claims-based analysis.ParticipantsA nationally representative sample of commercial insurance beneficiaries who received care between 2007 and 2015.MethodsWe limited the study population to beneficiaries with incident CSC diagnosed by an eye care provider, excluding those with other major ophthalmologic comorbidities. We developed a non-CSC comparison cohort matched to CSC patients by age, sex, general health (Charlson Comorbidity Index), and geographic region. We compared systemic corticosteroid prescriptions before and after CSC diagnosis and by diagnosing provider (optometrist vs. ophthalmologist) and evaluated likelihood of steroids treatment among CSC versus matched control patients using logistic and Cox proportional hazard regression models.Main Outcome MeasuresSystemic corticosteroid prescription frequency among CSC patients within 12 months pre-diagnosis and at 6, 12, and 24 months post-diagnosis, median time to steroid initiation and discontinuation, and odds of receiving steroids post-diagnosis among CSC and control patients.ResultsWe identified 3418 CSC patients. Nearly 39% (n = 1326) were prescribed systemic steroids at some point during the analysis period, versus 23% of controls (4033 of 17 178 patients). Over 12% of CSC patients (n = 430) within 1 year pre-diagnosis, and nearly 12% (n = 404) within 1 year post-diagnosis. Most patients who received steroids after diagnosis were steroid naive (n = 231). Among those receiving steroids, CSC patients demonstrated longer median time to first post-diagnosis steroid prescription (1.82 years vs. 0.50 years for non-CSC patients) and longer time to last steroid prescription (1.62 years vs. 0.35 years for non-CSC patients). Although CSC patients were significantly less likely to receive steroids within 6 months post-diagnosis compared with non-CSC patients (odds ratio, 0.72; 95% confidence interval, 0.59–0.89), they were significantly more likely to receive steroids by 2 years post-diagnosis. Prescribing patterns were similar for patients diagnosed by an ophthalmologist versus optometrist.ConclusionsDespite evidence showing that steroids contribute to CSC development, many patients continue to be prescribed systemic corticosteroids after CSC diagnosis. Our results suggest a need for greater communication and collaboration among providers to ensure that clinical practice reflects evidence-based recommendations.
黄斑病是皮质类固醇的副作用。
DOI：
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发表时间：
1966
期刊：
Journal of the All-India Ophthalmological Society
影响因子：
--
作者：
I. Jain;K. Singh
通讯作者：
K. Singh
患者、医生和地理因素对原发性孔源性视网膜脱离治疗变化的相对影响。
影响因子：
13.7
作者：
Vail,Daniel;Pershing,Suzann;Reeves,Mary-Grace;Afshar,ArminR
通讯作者：
Afshar,ArminR
影响因子：
--
作者：
BOUZAS, EA;SCOTT, MH;KAISERKUPFER, MI
通讯作者：
KAISERKUPFER, MI