Real-world prescribing patterns of systemic immunomodulatory treatments among uveitis specialists

Abstract

Introduction: How uveitis specialists select immunomodulatory treatments (IMT) for noninfectious uveitis and how these prescribing patterns have evolved over time remain poorly understood. Methods: In this population-based cross-sectional study, we assessed practical and financial variations associated with IMT in uveitis. We comprehensively analyzed Medicare Part D prescription records spanning from 2013 to 2021, cross-referencing it with unique identifiers of uveitis specialists. We utilized the American Uveitis Society and the Ocular Immunology and Uveitis Foundation member directories to identify US-based uveitis specialists. Our focus was on the prescribing patterns and associated costs of the commonly prescribed IMTs, including methotrexate, mycophenolate mofetil, azathioprine, and adalimumab. Results: We included data on 158 (43 % females) uveitis specialists who prescribed medications for 593,211 Medicare beneficiaries. IMTs represented 3.9 % (60,973) of their total prescriptions. From 2013 to 2021, there was a significant expansion in IMT prescriptions, increasing from 4115 (3 %) to 10,701 (5.1 % of all drugs, p < 0.001). Notably, during the COVID-19 pandemic in 2020–2021, IMT prescriptions grew 11 % annually. Over the study period, prescriptions for methotrexate (regression coefficient: 0.65, p = 0.049), mycophenolate mofetil (−1.55, p < 0.001), and azathioprine (−0.28, p = 0.02) declined. In contrast, utilization of adalimumab markedly increased from 0.93 % in 2013 to 18.5 % of IMT prescriptions in 2021, particularly after receiving approval from the Food and Drug Administration (FDA) in 2016 (4.81, p = 0.002). Adalimumab emerged as the most expensive IMT, averaging $6683/prescription and constituting 73.5 % of total IMT expenditure. Average costs for other drugs ranged from $52 (methotrexate) to $148.3 (mycophenolate mofetil). During the study period, adalimumab costs increased substantially (571.55, p < 0.001), while methotrexate costs declined (−3.3, p = 0.003). Discussion: Uveitis specialists’ preferences in managing noninfectious uveitis in Medicare patient population are evolving and can be influenced by several factors, including drug efficacy, FDA approvals, costs, and insurance considerations. Effective management requires evaluating treatment patterns and cost-effectiveness.

Keywords

• Uveitis
• Immunomodulatory treatment
• Adalimumab
• Practice pattern