Pos0652 interobserver Reliability and Sensitivity to Change of a Composite Ocular Inflammatory Activity Index: Uvedai

Abstract

BackgroundStandardized and validated outcome measures of disease activity are lacking in the treatment and assessment of uveitis, making it difficult to compare efficacy and response to treatment. In 2014, this working group developed a composite index of ocular inflammatory activity, UVEDAI, which includes 7 variables. The index was validated in a subsequent study conducted in 2019.ObjectivesTo determine the interobserver reliability and to demonstrate the sensitivity to change of the UVEDAI index in patients with anterior and non-anterior uveitis who undergo pharmacological treatment.MethodsThe design is an observational, longitudinal, prospective, multicentre study in 7 Spanish hospitals. Patients over 18 years of age diagnosed with active uveitis were included. A complete baseline visit was performed by two ophthalmologists who determined ocular inflammatory activity with the UVEDAI index independently and without contact between them. Ophthalmologist 1 made a new visit at 4 weeks to determine the change in the level of uveal inflammatory activity using the UVEDAI index. The interobserver reliability analysis was performed by calculating the Intraclass Correlation Coefficient (ICC), with the values of the variables and the UVEDAI index obtained by ophthalmologist 1 and ophthalmologist 2 in the most inflamed eye at the baseline visit. Sensitivity to change in the UVEDAI index was assessed at 4 weeks from the start of pharmacological treatment by determining the Clinically Relevant Change (CCR) defined as a change in UVEDAI of 0.8 points between the baseline visit and the 4-week visit.ResultsA total of 111 patients were included, 54.1% were male and the mean age at the time of the visit was 49.9 years. 36.9% of uveitis were idiopathic uveitis, and 58.6% were anterior uveitis. The UVEDAI value was calculated from the score obtained in the 7 variables of the index. The mean value recorded in the most inflamed eye at the baseline visit by ophthalmologist 1 was 1.9, being 1.2 points for anterior uveitis and 2.8 points for intermediate/posterior uveitis. In the interobserver reliability analysis, the ICC for the UVEDAI value was 0.9, and when compared to the mean UVEDAI values obtained by the two ophthalmologists for the most inflamed eye at the baseline visit, no statistically significant differences were found (p-value>0.05), neither for the total sample nor differentiating by anatomical location. As for sensitivity of UVEDAI change, statistically significant differences (p-value=0.00) were found when comparing the mean values of the index measured by ophthalmologist 1 at the baseline visit and at 4 weeks, both in the overall sample and differentiating by anatomic location of uveitis. In all cases, the index value decreased significantly by more than 1 point at the 4-week visit after pharmacological treatment.ConclusionThe interobserver reliability of the UVEDAI was high in the total sample and in the different variables. Furthermore, the index was sensitive in determining the change in inflammatory activity after treatment in both anterior uveitis and intermediate/posterior uveitis/panuveitis. We believe it is an index of activity that could be used both in routine clinical practice and in clinical studies and trials to compare results objectively.Reference[1]Pato-Cour E, Martin-Martinez MA, Castelló A, et al. Development of an activity disease score in patients with uveitis (UVEDAI). Rheumatol Int. 2017;37(4):647-65.Figure Interobserver ReliabilityDifferences obtained in the UVEDAI index score by ophthalmologist 1 and 2 at the baseline visit.Figure 1.Table Sensitive to ChangeMean value and difference in UVEDAI index value measured by ophthalmologist 1 in the active eye at baseline and at 4 weeks.Table 1.Anatomical LocationAnteriorIntermediate/Posterior/PanuvetisTotalUVEDAI INDEX baseline.opht.1*1,2 ± 1,62,8 ± 1,81,9 ± 1,8UVEDAI INDEX visit 4 wks.opht1*0,2 ± 0,51,2 ± 1,50,6 ± 1,1UVEDAI difference1.041.541.25p-value0.000.000.00*mean ± standard deviationDisclosure of InterestsNone Declared.