Kim Jiyeong, Kwon Hyeon Yoon, Ahn Seong Joon
Department of Pre-Medicine, College of Medicine and Biostatistics Laboratory, Medical Research Collaborating Center, Hanyang University, Seoul, Republic of Korea.
Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea.
Front Pharmacol. 2024 Oct 15;15:1461111. doi: 10.3389/fphar.2024.1461111. eCollection 2024.
Ethambutol, a key anti-tuberculosis medication, is associated with optic neuropathy, which can lead to significant vision impairment. This population-based cohort study investigated the nationwide usage of ethambutol and the incidence and screening of optic neuropathy among ethambutol users.
The cohort included 206,157 individuals from the Health Insurance Review and Assessment database in South Korea who initiated ethambutol therapy between 1 January 2015, and 31 December 2021. Among them, 117,309 individuals without prior ophthalmic diseases were analyzed to investigate practice patterns. The timing of the baseline examinations (an ophthalmic examination immediately preceding [within 1 month] ethambutol initiation or the first ophthalmic assessment conducted after the initiation) and subsequent monitoring and modalities used were assessed.
The cumulative incidences of the optic neuropathy categories, overall optic neuropathy, optic neuropathy/optic neuritis, and optic atrophy, were analyzed. The annual number of ethambutol users declined over time between 2015 and 2021. The cumulative incidences of overall optic neuropathy, optic neuropathy/optic neuritis, and optic atrophy were 2.8%, 2.0%, and 0.7%, respectively. Optical coherence tomography usage for ophthalmic examinations remarkably increased from 23.9% in 2015 to 85.5% in 2021, while visual field examinations were frequently (69.6%) employed for functional assessment at the time of diagnosis. Baseline screening within 6 months of initiating ethambutol therapy was performed in 12.0%-13.1% of ethambutol initiators annually over the study period. The percentage of ethambutol initiators receiving subsequent monitoring within 6 months following baseline screening declined over time, from 13.1% in 2015 to 7.9% in 2021.
The diminishing trend in monitoring emphasizes the need for improved pharmacovigilance to reduce the risk of optic atrophy and blindness through early detection.
乙胺丁醇是一种关键的抗结核药物，与视神经病变有关，可导致严重的视力损害。这项基于人群的队列研究调查了乙胺丁醇在全国范围内的使用情况以及乙胺丁醇使用者中视神经病变的发病率和筛查情况。
该队列包括来自韩国健康保险审查与评估数据库的206,157名个体，他们在2015年1月1日至2021年12月31日期间开始接受乙胺丁醇治疗。其中，对117,309名无既往眼科疾病的个体进行分析，以调查实践模式。评估了基线检查的时间（乙胺丁醇开始前[1个月内]的眼科检查或开始后进行的首次眼科评估）以及随后的监测和使用的方式。
分析了视神经病变类别、总体视神经病变、视神经病变/视神经炎和视神经萎缩的累积发病率。2015年至2021年期间，乙胺丁醇使用者的年度数量随时间下降。总体视神经病变、视神经病变/视神经炎和视神经萎缩的累积发病率分别为2.8%、2.0%和0.7%。眼科检查中光学相干断层扫描的使用从2015年的23.9%显著增加到2021年的85.5%，而视野检查在诊断时经常（69.6%）用于功能评估。在研究期间，每年有12.0%-13.1%的乙胺丁醇起始者在开始乙胺丁醇治疗的6个月内进行基线筛查。在基线筛查后6个月内接受后续监测的乙胺丁醇起始者的百分比随时间下降，从2015年的13.1%降至2
