Real-world treatment patterns in patients with systemic lupus erythematosus: associations with comorbidities and damage

Abstract

Objective: To assess treatment patterns and the association between long-term glucocorticoid (GC) and hydroxychloroquine (HCQ) use and damage accrual in patients with systemic lupus erythematosus (SLE).

Methods: A retrospective study including patients with SLE using the computerised database of a large health maintenance organisation. Patients were matched with subjects from the general population. Multivariable logistic regression models were used to assess the association between GC cumulative daily doses, HCQ and comorbidities: Osteoporosis, cardiovascular disease (CVD), hypertension and diabetes mellitus. Models were adjusted for age, sex, socioeconomic status, smoking, disease duration and HCQ use.

Results: A total of 1073 patients with SLE were included, 87.79% were women. The age at first diagnosis was 37.23±14.36 and the SLE disease duration was 12.89±6.23 years. Initiation of HCQ within 12 months of SLE diagnosis increased from 51.02% in 2000 to 83.67% in 2010 and 93.02% in 2018. The annual usage of GC gradually decreased from 45.34% in 2000 to 30.76% in 2020. CVD and osteoporosis were more prevalent in SLE than in the general population. Multivariable logistic regression models revealed increased odds for comorbidities in patients receiving a mean daily dose of prednisone of more than 5 mg/day compared with those receiving 5 mg/day or less.

Conclusions: CVD and osteoporosis were more prevalent in SLE than in the general population. The dose and frequency of GC treatment in patients with SLE have decreased over the years. Prednisone usage in doses exceeding 5 mg/day is associated with significantly increased odds of osteoporosis and CVD.

Keywords: Cardiovascular Disease; Epidemiology; Glucocorticoids; Osteoporosis; Systemic Lupus Erythematosus.

Figure 1. (a) Initiation of hydroxychloroquine treatment in the first 12 months after the diagnosis of systemic lupus erythematosus by diagnosis year 2000–2018. (b) Annual hydroxychloroquine purchase among prevalent patients with systemic lupus erythematosus 2000–2020.

Figure 2. (a) Annual glucocorticoids use among prevalent patients with systemic lupus erythematosus 2000–2020. (b) Glucocorticoids use in the first 5 years from diagnosis among patients diagnosed during 2000–2018.