AB1019 TREATMENT OF SYSTEMIC LUPUS ERYTHEMATOSUS: ANALYSIS OF TREATMENT PATTERNS IN ADULT AND PAEDIATRIC PATIENTS ACROSS FOUR EUROPEAN COUNTRIES
Authors: F. Dernie, M. Du, M. Catala Sabate, A. Delmestri, W. Y. Man, J. Brash, H. Van Ballegooijen, N. Mercadé-Besora, T. Duarte-Salles, M. A. Mayer, A. Leis, J. M. Ramirez-Anguita, R. Griffier, G. Verdy, A. Prats-Uribe, A. Pacurariu, D. Morales, R. De Lisa, S. Galluzzo, G. Egger, D. Prieto-Alhambra, E. H. Tan
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Systemic lupus erythematosus (SLE) is a complex autoimmune disease with multiple treatment options recommended by clinical guidelines. Understanding treatment patterns among SLE patients is important for assessing treatment burden, the impact of clinical guidelines, and guiding medicinal product development. However, only limited data on treatment patterns exist in SLE, especially in paediatric-onset SLE. <h3>Objectives:</h3> To characterise adult and paediatric patients diagnosed with SLE at the time of diagnosis, and describe the patterns of medications used to treat their condition. <h3>Methods:</h3> We conducted a cohort study using five databases of routinely collected healthcare data from four European countries. Data sources include three primary or outpatient care databases [Clinical Practice Research Datalink (CPRD) GOLD (UK), IQVIA Disease Analyzer (DA) Germany (DE), Sistema d'Informació per al Desenvolupament de la Investigació en Atenció Primària (SIDIAP) (ES)], and two hospital databases [Institut Municipal Assistència Sanitària Hospital del Mar Information System (IMASIS) (ES) and Clinical Data Warehouse of Bordeaux University Hospital (CDWBordeaux) (FR)]. We described the characteristics of adult and paediatric (&lt;18 years) patients at time of SLE diagnosis, including age, sex, comorbidities, and concurrent medication use. We analysed the different medicines used, calculated the percentage of SLE patients commencing pre-specified SLE treatments in the first month and year after diagnosis, reported number of prescriptions, starting dose, cumulative dose, and duration of treatment for each of the treatments, and characterised which drugs were used as first-line or second-line treatments. <h3>Results:</h3> We included 11,255 patients with a first diagnosis of SLE for patient characterisation and 5,718 for our medicine utilisation analyses. Across all databases, the majority of adult SLE patients were female (80-88%), with median age of 49 to 54 years at diagnosis. In the paediatric cohort, 66-83% of SLE patients were female, with median age of 12 to 16 years at diagnosis. Hydroxychloroquine and glucocorticoids were most used as first line treatments in both adults and paediatric patients, with second line treatments including mycophenolate mofetil and methotrexate. Relatively few cases of monoclonal antibody use were seen in both groups. Initial glucocorticoid dosing in paediatric patients was often higher than in adults. In the paediatric cohort, for hydroxychloroquine, median duration was between 50 to 501 days across primary care databases and 8 days for CDWBordeaux hospital, median initial daily dose ranged from 199 to 300 mg, median cumulative dose ranged from 20,000 to 116,600 mg, number of prescriptions in the first drug era was 1 to 10 across all databases. For prednisone/prednisolone, median duration was between 74 to 246 days for primary care databases and 13 days for CDWBordeaux hospital, median initial daily dose ranged from 10 to 60 mg, median cumulative dose ranged from 775 to 2,150 mg, number of prescriptions in the first drug era was 1 to 5 across all databases. In the adult new user cohort, for hydroxychloroquine, median duration was 39 to 485 days for primary care databases and 4 to 30 days for hospital databases, median initial daily dose ranged from 13 to 400 mg, median cumulative dose ranged from 600 to 130,051 mg, number of prescriptions in the first drug era was 1 to 6 across all databases. For prednisone/prednisolone, median duration was 7 to 111 days for primary care databases and 4 to 30 days for hospital databases, median initial daily dose ranged from 2 to 40 mg, median cumulative dose ranged from 20 to 1,038 mg, number of prescriptions in the first drug era was 1 to 4 across all databases. <h3>Conclusion:</h3> Our results show that treatment choices for SLE in adults across four European countries are overall in line with most recent therapeutic consensus guidelines. A higher prescription of glucocorticoids seen in paediatric patients suggests the need for effective steroid-sparing treatment alternatives as indicated by paediatric specific guidelines. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> This study is based in part on data from the Clinical Practice Research Datalink obtained under license from the UK Medicines and Healthcare products Regulatory Agency. The data is provided by patients and collected by NHS as part of their care and support programme. The views expressed in this article are the personal views of the author(s) and should not be understood or quoted as being made on behalf of or reflecting the position of the regulatory agency/agencies or organisations with which the author(s) is/are employed/affiliated. <h3>Disclosure of Interests:</h3> Francesco Dernie: None declared, Mike Du: None declared, Marti Catala Sabate: None declared, Antonella Delmestri: None declared, Wai Yi Man: None declared, James Brash Employee of IQVIA, Hanne van Ballegooijen Employee of IQVIA, Núria Mercadé-Besora: None declared, Talita Duarte-Salles: None declared, Miguel-Angel Mayer: None declared, Angela Leis: None declared, Juan Manuel Ramirez-Anguita: None declared, Romain Griffier: None declared, Guillaume Verdy: None declared, Albert Prats-Uribe: None declared, Alexandra Pacurariu: None declared, Daniel Morales: None declared, Roberto De Lisa: None declared, Sara Galluzzo: None declared, Gunter Egger: None declared, Daniel Prieto-Alhambra DPA's research group has received consultancy fees from Astra Zeneca and UCB Biopharma., DPA's department has received grant/s from Amgen, Chiesi-Taylor, Lilly, Janssen, Novartis, and UCB Biopharma. Amgen, Astellas, Janssen, Synapse Management Partners and UCB Biopharma have funded or supported training programmes organised by DPA's department., Eng Hooi Tan: None declared.