Predictors of Glucocorticoid Use for Acute Optic Neuritis in the United States, 2005-2019

ABSTRACT

Purpose

Acute optic neuritis (ON) is variably treated with glucocorticoids. We aimed to describe factors associated with glucocorticoid use.

Methods

In this retrospective, longitudinal cohort study of insured patients in the United States (2005–2019), adults 18–50 years old with one inpatient or ≥2 outpatient diagnoses of ON within 90 days were included. Glucocorticoid use was classified as none, any dose, and high-dose (>100 mg prednisone equivalent ≥1 days). The primary outcome was glucocorticoid receipt within 90 days of the first ON diagnosis. Multivariable logistic regression models assessed the relationship between glucocorticoid use and sociodemographics, comorbidities, clinician specialty, visit number, and year.

Results

Of 3026 people with ON, 65.8% were women (n = 1991), median age (interquartile range) was 38 years (31,44), and 68.6% were white (n = 2075). Glucocorticoids were received by 46% (n = 1385); 54.6% (n = 760/1385) of whom received high-dose. The odds of receiving glucocorticoids were higher among patients with multiple sclerosis (OR 1.61 [95%CI 1.28–2.04]; P < .001), MRI (OR 1.75 [95%CI 1.09–2.80]; P = .02), 3 (OR 1.80 [95%CI 1.46–2.22]; P < .001) or more (OR 4.08 [95%CI 3.37–4.95]; P < .001) outpatient ON visits, and in certain regions. Compared to ophthalmologists, patients diagnosed by neurologists (OR 1.36 [95%CI: 1.10–1.69], p = .005), emergency medicine (OR 3.97 [95%CI: 2.66–5.94]; P < .001) or inpatient clinicians (OR 2.94 [95%CI: 2.22–3.90]; P < .001) had higher odds of receiving glucocorticoids. Use increased 1.1% annually (P < .001).

Conclusions

Demyelinating disease, care intensity, setting, region, and clinician type were associated with glucocorticoid use for ON. To optimize care, future studies should explore reasons for ON care variation, and patient/clinician preferences.

KEYWORDS:

• Optic neuritis
• glucocorticoids
• utilization
• prescribing

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

This work was supported by the National Eye Institute under grant K23EY027849 (LBD);National Center for Advancing Translational Sciences [5KL2TR002241];National Institute on Aging [R01 AG059733];National Institute on Minority Health and Health Disparities [R01 MD008879];