Timing of corticosteroid-sparing therapies in non-infectious uveitis: a population-based cohort study from Denmark

Non-infectious uveitis (NIU) is a group of potentially vision-threatening diseases where timely management is critical, yet data on the timing and sequencing of therapeutic interventions remain limited. Here, we evaluated real-world patterns and delays in initiating key NIU therapies over time.

A total of 1218 patients with NIU referred to a hospital-based ophthalmology clinic in the North Denmark Region between 2010 and 2024 were included. The timing of treatment initiation with periocular corticosteroid injections, intravitreal dexamethasone implants (IDI), systemic prednisolone, or disease-modifying antirheumatic drugs (DMARDs), was analysed using cumulative incidence and incidence rates. Associations between patient characteristics and treatment initiation were assessed using Cox proportional-hazards models.

Systemic prednisolone and periocular corticosteroid injections were initiated rapidly, with most treatments administered within the first three months after referral. IDI treatment was initiated later, with few patients receiving IDI during the first year. Initiation of DMARD therapy occurred gradually over the first year. At five years, cumulative incidences were: periocular corticosteroid injections 6.2% (95% CI: 4.9-7.9), IDI 2.6% (95% CI: 1.8-3.8), systemic prednisolone 11.3% (95% CI: 9.6-13.3), and DMARDs 4.1% (95% CI: 3.1-5.5). IDI use was more likely in intermediate, posterior, and panuveitis while DMARDs were more frequently initiated in patients with bilateral disease.

Systemic and periocular corticosteroids injections were used frequently and early, while IDI and DMARDs were introduced later. These findings may reflect the clinical characteristics of this cohort and potential barriers to timely corticosteroid-sparing therapies and highlight the importance of continued efforts to optimise timing of treatment in the management of NIU.