Risk of Non-Infectious Uveitis Associated with Medications for Substance Use Disorders

PURPOSE: The association between drugs used for medication-assisted treatment (MAT) and the risk of noninfectious uveitis (NIU) remains unclear. To this end, we aimed to evaluate the risk of NIU in patients prescribed MAT compared with those prescribed selective serotonin reuptake inhibitors (SSRIs). METHODS: This retrospective, population-based cohort study utilized aggregated, deidentified electronic health record data from the TriNetX Research Network. Analyses were conducted with and without exclusions for specific inflammatory risk factors. The control cohort comprised patients prescribed SSRIs, matched for age, sex, race, ethnicity, and smoking status. We compared the prescription of MAT to SSRIs to ascertain NIU risk against a risk-neutral medication. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated to assess the association between MAT and NIU risk. Analyses included specific NIU subtypes: anterior, intermediate, posterior, and pan-uveitis. RESULTS: In the low inflammatory risk analysis, MAT prescriptions were not associated with increased risk of NIU through 6 months post prescription compared with SSRIs. In the real-world analysis, MAT prescriptions were associated with an increased risk of posterior NIU at 1 month (RR, 1.44; 95 % CI: 1.11-1.85), 3 months (RR, 1.44; 95 % CI: 1.14-1.83), and 6 months (RR, 1.44; 95 % CI: 1.16-1.80). CONCLUSIONS: MAT prescriptions may be associated with a mild increased risk of posterior NIU in the real-world setting, but not the low inflammatory risk setting, compared with SSRIs. These findings suggest a potential benefit of ophthalmologic monitoring in patients prescribed MAT, although institutional studies reviewing each medication are necessary to confirm these results.