Expert advises against ‘doctor-shopping’ for uveitis treatment

Marian Chu  Published 2018.08.02  15:37  Updated 2018.08.02 15:37


A Korean expert noted the difficulties of treating uveitis in Korea, saying that patients who do not see benefits of treatment often switch doctors continuously in practice called “doctor-shopping.”

Professor Song Ji-hoon from Ajou University Hospital Department of Ophthalmology lectures on uveitis treatment at an AbbVie media day held in Gangnam, southern Seoul, on Wednesday.

Uveitis is an inflammation of the uvea, which is the middle layer of the eye that holds the iris, ciliary body, and choroid. It is the third leading cause of blindness. About 10 people out of 10,000 are affected by the condition in Korea.

About 60 different causes exist for uveitis, which makes pinpointing the cause extremely difficult and requires extensive trial and error in treatment.

In most cases, physicians use a step-ladder approach that starts with prescribing steroid drugs, which often cause a variety of side effects. Physicians then add an oral nonsteroidal anti-inflammatory drug. The next step is to to proceed to use immunomodulatory, chemotherapeutic medicines if the uveitis progress or recur each time steroid medications are tapered off. If the condition remains uncontrolled, treatment continues to incorporate biologic agents such as Humira (adalimumab).

Because of this long trial-and-error process, many patients often switch doctors in the process leading to a worse prognosis, according to Professor Song Ji-hoon from Ajou University Hospital Department of Ophthalmology.

“Many patients go doctor shopping in the middle of treatment. They move hospitals, too. In cases like these, the long-term effects get worse,” Song said. “In uveitis, the doctor and the patient relationship become much more important than in other chronic diseases.”

Song added that treatment with Humira had shown substantial effect, especially following the reimbursement of the therapy earlier this year.

Humira is a tumor necrosis factor-alpha((TNF-α)-inhibiting, anti-inflammatory biologic medication that is used to treat a variety of diseases such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and Crohn's disease, among others. The therapy developed by AbbVie gained insurance coverage in Korea in April this year to treat children with chronic non-infectious anterior uveitis from the Ministry of Food and Drug Safety.

The approval was based on results of VISUAL trials, which are composed of VISUAL-I and VISUAL-II trials. In the VISUAL-I trial, 217 patients with noninfectious uveitis who had been treated with corticosteroids were divided into a Humira and placebo group. Findings showed the length until failure of treatment was 13 weeks in the placebo group and 24 weeks in the Humira group.

Song stressed that the social and economic costs of uveitis are substantial due to loss of workforce from loss of vision.

“Because about 70 to 90 percent of patients who get uveitis are in their prime working years, problems such as loss of vision makes it impossible to work, making socioeconomic damage potentially severe,” the professor said.

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