AB0981 REAL-WORLD TREATMENT PATTERNS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS - INCREASED PRESCRIPTION OF HYDROXYCHLOROQUINE DOES NOT INCREASE ITS UPTAKE, WHILE REDUCED PRESCRIPTION OF CORTICOSTEROIDS RESULTS IN REDUCED DAMAGE ACCRUAL
Authors: T. Eviatar, R. Yahalom-Golan, I. Livnat, M. Elboim, G. Chodick, V. Rosenberg, D. Paran
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Prognosis, damage, and outcomes in systemic lupus erythematosus (SLE) are affected by race and ethnicity and may be influenced by treatment patterns and glucocorticoid use. The epidemiology of SLE in Israel is not well defined. <h3>Objectives:</h3> To assess treatment patterns of SLE patients in Israel, and the association between cumulative daily doses of corticosteroids (CS) and comorbidities. <h3>Methods:</h3> A retrospective study using the computerized database of Maccabi Healthcare Services (MHS), a large health maintenance organization. Prevalent SLE patients on Dec 31 2020 were defined according to the presence of the following: first SLE diagnosis at the age of ≥10 years, ≥1 purchase of hydroxychloroquine (HCQ) and ≥1 positive anti-nuclear antibody test. Patients diagnosed with dermatomyositis or systemic sclerosis were excluded. Patients with SLE were matched in a ratio of 1:5 to individuals from the general MHS population, by age, sex, and socioeconomic status (SES). Treatment patterns were examined annually during 2000-2020. Initiation of HCQ in the year after the first SLE diagnosis was defined by ≥1 purchase, as was annual uptake of HCQ. Annual uptake of CS was defined by purchases of oral prednisone. Descriptive statistics were used to characterize SLE patients and examine their treatment patterns. Multivariate logistic regression models were used to assess the association between cumulative CS daily doses since the first SLE diagnosis and the following comorbidities (defined according to MHS registries): osteoporosis (OP), cardiovascular disease (CVD), hypertension, and diabetes mellitus (DM). All models were adjusted for age, sex, socioeconomic status, smoking status, and disease duration. <h3>Results:</h3> We identified 1073 SLE patients (prevalence rate 52.2 per 100,000), 87.8% were female. The mean age at disease onset was 37.23±14.36 years, and disease duration was 12.89±6.23 years. Initiation of HCQ in the first year after diagnosis increased from 51.0% in 2000 to 83.7% in 2010, reaching 93.0% in 2018. The annual uptake of HCQ increased from 55.3%-63.8% during 2000-2006 to 66.4%-69.5% during 2008-2020. The annual usage of CS gradually decreased from 45.3% in 2000, to 36.4% in 2010 and reached 30.8% in 2020. Moreover, the annual proportion of patients treated with CS at a mean dose of prednisone of ≥7.5 mg/day decreased from 13.6% in 2000, to 11.5 % in 2010 and 7.2% in 2020 (<b>Figure 1</b>). OP and CVD were more prevalent in SLE patients compared to controls (OP 29.8% vs. 11.2%; CVD 36.7% vs. 11.8%, respectively, p&lt;0.001 for both). The multivariable models showed that compared to patients not treated with CS or treated with a mean dose of prednisone of ≤ 5 mg/day, those treated with ≥5 mg/day, had significantly increased odds for all the comorbidities included in this study (p&lt; 0.05; <b>Table 1</b>). The results remained consistent when the analysis was restricted to those ever treated with CS. <h3>Conclusion:</h3> Glucocorticoid treatment in SLE patients has decreased over the years in rate and dose. The use of mean doses of prednisone of 5 mg/day or more was associated with increased odds of OP, CVD, hypertension, and DM. Although the prescription of HCQ has increased over the years, it was not accompanied by a similar increase in the annual HCQ uptake. Our findings reinforce the need for better uptake of HCQ, judicious use of CS, better strategies to mitigate comorbidities, and better steroid sparing agents. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> The study was funded by AstraZeneca, the company was not involved in data analysis. <h3>Disclosure of Interests:</h3> Tali Eviatar GSK, Abbvie, Abbvie, AstraZeneca, AstraZeneca, Roni Yahalom-Golan AstraZeneca, Idit Livnat AstraZeneca, Moran Elboim AstraZeneca, Gabriel Chodick: None declared, Vered Rosenberg: None declared, Daphna Paran AstraZeneca, AstraZeneca.