(314) Treatment of systemic lupus erythematosus: analysis of treatment patterns in adult and paediatric patients across four European countries

Background: 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 and the impact of clinical guidelines. However, only limited data on treatment patterns exist in SLE, especially in paediatric-onset SLE.

Objectives: To investigate the treatment choices and characteristics for SLE patients in UK, Germany, Spain and France.

Methods: We conducted a cohort study using 5 healthcare databases between 2013 to 2022. Data sources include 3 primary/outpatient care databases [Clinical Practice Research Datalink (CPRD) GOLD (UK), IQVIA Disease Analyzer (DA) Germany (DE), Information System for Research in Primary Care (SIDIAP) (ES)], and 2 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 ( < 18 years) SLE patients at first diagnosis, such as age, sex, comorbidities, and concurrent medication use. We also reported information of drugs used such as duration, initial dosage, cumulative dosage, and prescriptions count. Additionally, we identified drugs used for first and second-line treatment.

Results: We included 11,255 patients with a first diagnosis of SLE for patient characterisation and medicine utilisation analyses. Predominantly female (80-88%), adults had a median diagnosis age of 49-54, while the median age for paediatric cohort were 12 to 16 years at diagnosis. Hydroxychloroquine and glucocorticoids were most used as first-line treatments in both adult and paediatric patients, with second-line treatments including mycophenolate mofetil and methotrexate. Monoclonal antibody use was rare in both groups. Paediatric patients often received higher initial glucocorticoid doses compared to adults. For example, in the primary care data, median duration of prednisone/prednisolone ranged from 74 to 246 days in paediatrics vs 7 to 111 days in adults, initial daily dose ranged from 10 to 60 vs 2 to 40 mg, and cumulative dose ranged from 775 to 2,150 vs 20 to 1038 mg. Hospital database results were similar to primary care databases but with shorter treatment durations.

Conclusions: Our results show that treatment choices for SLE in adults in the four countries were in line with the most recent therapeutic consensus guidelines. A higher prescription of glucocorticoid seen in paediatric patients suggests the need for effective steroid-sparing treatment alternatives as indicated by paediatric-specific guidelines.