Glucocorticoids prescribing practices in systemic sclerosis: an analysis of the EUSTAR database
Authors: Iudici Michele , Mongin Denis , Siegert Elise , Carreira Patricia E , Distler Jörg , Henes Jörg , Zanatta Elisabetta , Hachulla Eric , De Luca Giacomo , de Souza Müller Carolina , Santiago Tânia , Tandaipan José-Luis , Valdetaro Bianchi Breno , De Santis Maria , Hoffmann-Vold Anna-Maria , Gabrielli Armando , Distler Oliver , Courvoisier Delphine Sophie ,   EUSTAR collaborators, Cuomo Giovanna , Moroncini Gianluca , Stork Jiri , Iannone Fiorenzo , Walker Ulrich , Bertoldo Eugenia , Krasowska Dorota , Salvador Maria João , Tikly Mohammed , Riccieri Valeria , Sha Ami , Gheorghiu Ana Maria , Sunderkötter Cord , Ingegnoli Francesca , Mouthon Luc , Smith Vanessa , Cantatore Francesco Paolo , Eyerich Kilian , Wiland Piotr , Vanthuyne Marie , Anic Branimir , Üprus Maria , Granel Brigitte , Vacca Alessandra , Tanaseanu Cristina-Mihaela , Lefebvre Paloma García de la Peña , Sibilia Jean , Litinsky Ira , Saketkoo Lesley Ann , Kerzberg Eduardo , Limonta Massimiliano , Rimar Doron , Sfikakis Petros , Cutolo Maurizio , Foti Rosario , Novak Srdan , Radic Mislav , Pellerito Raffaele , Rozzano Carlo Francesco Selmi , Ananieva Lidia P , Szűcs Gabriela , de la Puente Carlos , Ionescu Ruxandra Maria , Pozzi Maria Rosa , Alegre-Sancho Juan Jose , Herrmann Kristine , De Langhe Ellen , Altunizade Sule Yavuz , Agachi Svetlana , Veale Douglas , Loyo Esthela , Li Mengtao , Rosato Edoardo , Maurer Britta , Castellví Iván , Spertini François , Solanki Kamal , Del Papa Nicoletta , Espinosa Gerard , Czirják László , Coleiro Bernard , Bancel Dominique Farge , Pellerito Raffaele , Denton Christopher , Damjanov Nemanja , Granollers Vera Ortiz Santamaria , Kohm Michaela , Stamenkovic Bojana , Allanore Yannick , Airo’ Paolo , Balbir-Gurman Alexandra , Cerinic Marco Matucci , Riemekasten Gabriela , Heitmann Stefan , Hunzelmann Nicolas , Montecucco Carlomaurizio , Morovic-Vergles Jadranka , Ribi Camillo 
Published: September 2022

Objectives

To estimate the prevalence of long-term exposure to glucocorticoids (GCs) and to identify factors associated with, and variations in prescribing practices over time and across recruiting countries.

Methods

We included patients with SSc having a visit recorded in the EUSTAR database from January 2013 onward. We analysed the prevalence and the main features of GCs users, their exposure to GCs over time, and their GCs dosages. Multivariable linear regression was used to analyse the factors identified as associated with GCs intake duration. Time trends, and variations in GCs utilization across recruiting countries were explored. Missing data were imputed using multiple imputation with chained equations.

Results

The 9819 patients included were mostly females (85%), the majority had lcSSc (73%), and the median age was 58 years. At baseline, 34% of patients (n = 2769/8109) (48% dcSSc vs 29% lcSSc) were on GCs, and the median dose was 7.5 mg/day. GCs users were more frequently males and anti-Scl70 positive, and more commonly had dcSSc and more severe disease. On average, GCs users spent 25% of their follow-up time (median 33.2 months) on GCs, with no significant between-subsets difference. Notably, 33% (n = 971/2959) and 22% (n = 647/2959) of patients followed up for &gt;1 year had received GCs for &gt;6 and &gt;12 months, respectively. Multivariable analysis showed that patient and disease characteristics poorly explained the variability in GCs exposure (adjusted-R2 = 0.06, P &lt; 0.001). GCs utilization varied within and across countries, and gradually decreased over time (36% in 2013 vs 23% in 2018).

Conclusions

GCs are widely and long-term prescribed in SSc, with significant between-countries and within-country differences. A gradual decrease in their utilization has been observed.