Uveitis, caused by inflammation of the eye’s uvea, presents as decreased or blurry vision, ocular ache, eye redness, photophobia, and/or floaters. Uveitis cases can vary depending on etiology, anatomy, laterality, duration, and frequency of episodes. While the majority of patients (70-90%) present with anterior uveitis, most uveitis-related vision loss results from chronic inflammation of the back segment of the eye (i.e., intermediate-, posterior-, or pan-uveitis). Intermediate-, posterior-, and pan-uveitis can be more difficult to manage, although, as for anterior uveitis, corticosteroids remain the clinical mainstay for posterior segment uveitis. Patients requiring long-term treatment or with refractory inflammation also may be treated with corticosteroid-sparing therapies, such as antimetabolites, alkylating agents, and/or biologic agents, alone or in combination with corticosteroids in order to avoid potential safety complications related to high dose or long-term corticosteroid treatment.

Using longitudinal U.S. claims data, this report examines current trends in the management of uveitis (intermediate, posterior, and panuveitis) for both newly diagnosed patients and patients filling a prescription for a key therapy in the third quarter of 2013. For the newly diagnosed patients, the report provides a quantitative analysis of treatment patterns and share by line of therapy as well as progression between lines, duration of treatment on each line, and use of concomitant treatment. For recently treated patients, the report quantifies a drug’s source of business compared with its competitors and details which drugs precede others through an analysis of add-versus-switch patterns. Additional analyses explore persistency and compliance by brand.

Questions Answered in This Report:

  • Newly diagnosed patients: Approximately 13% of patients with intermediate-, posterior-, or pan-uveitis begin treatment with a key therapy within a year of their initial diagnosis. What percentage of these patients progress to a second- or third-line drug within the first year? Which products capture the most patient share in the first, second, and third lines of treatment? How often is combination therapy used in each line of therapy?

  • Recently treated patients: Almost 80% of recently treated patient prescriptions are for a corticosteroid agent, with antimetabolites and biologic agents making up the remaining prescriptions. Which specific drugs garner the most patient share for recently treated uveitis patients? When do patients progress from one therapy to the next in uveitis, and how does this pattern differ among key drugs? Are most recently treated patients with each key brand coming from new (adds/switches) or continuing business?

  • Pathways to key therapies: Longitudinal claims data reveal relatively consistent use patterns of key therapies among recently treated patients. Use of corticosteroids is dominant in earlier lines of therapy; corticosteroid-sparing approaches, via switching or polypharmacy with antimetabolites or biologic agents, are instituted in later lines of therapy. Which therapies have experienced market growth or decline over the key therapy periods studied? To what extent are key therapies prescribed concomitantly to recently treated patients? What has been the impact of recently approved drugs for uveitis?

Scope:

Primary patient-level data: This report provides quantitative findings from our analysis of data covering approximately 40 million lives and provides the most representative sample of U.S. treatment practice for Medicare and commercially insured patients. This report is delivered as a key findings slide deck and a dashboard that can be accessed using the Internet and presents claims that are less than six months old at the time of publication.

Patient Sample:

Patients who are continuously enrolled for the complete two-year study period must meet the following condition: at least one claim with a diagnosis code for intermediate-, posterior-, or pan-uveitis (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic codes 363.00, 363.01, 363.03 – 363.08, 363.10-363.15, 363.20, 363.12) during the study period.

Quantified lines of therapy analysis show exact share of each agent in each line of therapy, including rate of progression between lines and length of time patients are on each line.

Newly Diagnosed Patients:

- Patient share by drug class and key products across three lines of therapy, within one year of diagnosis.

- Patient flowchart through one year of treatment for all first-line products, including progression rates and add/switch behavior.

- Polypharmacy and key concomitant therapies by line of therapy.

- Quarterly trends in patient share by line of therapy.

Recently Treated Patients:

- Quarterly snapshot of patient share by drug class and key products.

- Pathway to key therapy flowcharts tracking the preceding therapy patterns for all key therapies, including add/switch behavior.

- Brand source of business, including share for continuing, new (switches/adds), and new (initial therapy) business.

- Polypharmacy and key concomitant therapies.

- Drug persistence and compliance.

- Quarterly trends in patient share for all key therapies.