Limitations of current treatments for systemic lupus erythematosus: a patient and physician survey

Abstract

An independent cross-sectional survey assessed systemic lupus erythematosus (SLE) disease and treatment burden. Variables included medication classes prescribed, disease activity, flare occurrences, treatment satisfaction, and validated measures of health-related quality of life (HRQoL), fatigue and work productivity. Of 886 eligible patients (mean age 41.3 years, 89% female), 515 completed the survey. One-third reported moderate-to-severe disease activity, and 31% had flared in the last 12 months. Higher severity of disease activity (moderate-to-severe) was associated with ≥ 2 medication classes prescribed and treatment regimens that included corticosteroids (CS) (both p<0.0001). Patients receiving CS reported lower EQ-5D scores (p=0.0019) and higher fatigue levels (p<0.001), and both patients (p=0.0019) and physicians (p=0.0001) were less likely to report satisfaction with treatment regimens including CS. Among responders eligible for work (n=456), severity of disease activity (moderate-to-severe vs. mild) was associated with unemployment (52.9% vs. 40.8%; p=0.0189), greater impairment in work productivity (36% vs. 21%; p=0.0003) and participation in daily activities (41% vs. 21%; p<0.0001). This survey confirms that SLE and current treatment options substantially impair patients' health status and work productivity. Physician- and patient-reported satisfaction with current treatment regimens, despite poorly controlled disease activity, indicate they are resigned to the limitations of available SLE treatment regimens.

Keywords: HRQoL; SLE; fatigue; productivity.