Treatment of systemic lupus erythematosus: Analysis of treatment patterns in adult and paediatric patients across four European countries

• Published in: European journal of internal medicine
• Main Authors: Du, Mike, Dernie, Francesco, Català, Martí, Delmestri, Antonella, Man, Wai Yi, Brash, James T., van Ballegooijen, Hanne, Mercadé-Besora, Núria, Duarte-Salles, Talita, Mayer, Miguel-Angel, Leis, Angela, Ramírez-Anguita, Juan Manuel, Griffier, Romain, Verdy, Guillaume, Prats-Uribe, Albert, Pacurariu, Alexandra, Morales, Daniel R., De Lisa, Roberto, Galluzzo, Sara, Egger, Gunter F., Prieto-Alhambra, Daniel, Tan, Eng Hooi
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 11-08-2024
• Subjects: Drug utilisation; Epidemiology; Lupus; Real world evidence; Systemic lupus erythematosus; Lupus; Real world evidence; Drug utilisation; Systemic lupus erythematosus; Epidemiology
• ISSN: 0953-6205; 1879-0828; 1879-0828
• DOI: 10.1016/j.ejim.2024.08.008

•Characteristics and treatment patterns of 11,255 systemic lupus erythematosus patients analysed across four countries.•Glucocorticoids and hydroxychloroquine were the most common first-line treatments.•Mycophenolate mofetil was the most common second-line treatment for both adults and pediatric patients.•Higher glucocorticoid doses were often prescribed to pediatric patients compared to adults.
Multiple treatment options are recommended for Systemic Lupus Erythematosus (SLE) by clinical guidelines. This study aimed to explore SLE treatment patterns as there is limited real-world data of SLE medication utilisation, especially in childhood-onset SLE (cSLE).
We conducted a longitudinal cohort study using five routinely collected healthcare databases from four European countries (United Kingdom, France, Germany, and Spain). We described the characteristics of adult and paediatric patients at time of SLE diagnosis. We calculated the percentage of patients commencing SLE treatments in the first month and year after diagnosis, reported number of prescriptions, starting dose, cumulative dose, and duration of each treatment, and characterised the line of therapy.
We characterised 11,255 patients with a first diagnosis of SLE and included 5718 in our medication utilisation analyses. The majority of adult SLE patients were female (range 80–88 %), with median age of 49 to 54 years at diagnosis. In the paediatric cohort (n = 378), 66–83 % of SLE patients were female, with median age of 12 to 16 years at diagnosis. Hydroxychloroquine and glucocorticoids were common first-line treatments in both adults and children, with second-line treatments including mycophenolate mofetil and methotrexate. Few cases of monoclonal antibody use were seen in either cohort. Initial glucocorticoid dosing in paediatric patients was often higher than in adults.
Treatment choices for adult SLE patients across four European countries were in line with recent therapeutic consensus guidelines. High glucocorticoid prescriptions in paediatric patients suggests the need for steroid-sparing treatment alternatives and paediatric specific guidelines.
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