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Glucocorticoid use and factors associated with variability in this use in the Systemic Lupus International Collaborating Clinics Inception Cohort

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Little J1,2, Parker B2, Lunt M1, Hanly JG3, Urowitz MB4, Clarke AE5, Romero-Diaz J6, Gordon C7,8, Bae SC9, Bernatsky S10, Wallace DJ11, Merrill JT12, Buyon J13, Isenberg DA14, Rahman A14, Ginzler EM15, Petri M16, Dooley MA17, Fortin P18, Gladman DD4, Steinsson K19, Ramsey-Goldman R20, Khamashta MA21, Aranow C22, Mackay M22, Alarcón GS23, Manzi S24, Nived O25, Jönsen A25, Zoma AA26, van Vollenhoven RF27, Ramos-Casals M28, Ruiz-Irastorza G29, Sam Lim S30, Kalunian KC31, Inanc M32, Kamen DL33, Peschken CA34, Jacobsen S35, Askanase A36, Sanchez-Guerrero J37, Bruce IN1,2. Rheumatology (Oxford). 2018 Jan 18. doi: 10.1093/rheumatology/kex444. [Epub ahead of print]

Abstract

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1 Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.

2 NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.

3 Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.

4 Lupus Program, Centre for Prognosis Studies in The Rheumatic Disease and Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, Canada.

5 Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

6 Instituto Nacional de Ciencias Médicas y Nutrición, Immunology and Rheumatology, Mexico City, Mexico.

7 Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.

8 Rheumatology department, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.

9 Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.

10 Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada.

11 Cedars-Sinai Medical Centre, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

12 Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.

13 Division of Rheumatology, Department of Medicine, New York School of Medicine, NY, USA.

14 Centre for Rheumatology, Department of Medicine, University College London, London, UK.

15 Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA.

16 Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

17 Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA.

18 Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Québec City, Canada.

19 Center for Rheumatology Research, Landspitali University hospital, Reykjavik, Iceland.

20 Division of Rheumatology, Feinberg School of Medicine, Northwestern University Chicago, IL, USA.

21 Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK.

22 Feinstein Institute for Medical Research, Manhasset, NY, USA.

23 Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.

24 Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, PA, USA.

25 Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden.

26 Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, UK.

27 Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm, Sweden.

28 Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain.

29 Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain.

30 Division of Rheumatology, Emory University School of Medicine, Atlanta, GA, USA.

31 University of California San Diego School of Medicine, La Jolla, CA, USA.

32 Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.

33 Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.

34 Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

35 Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

36 Hospital for Joint Diseases, New York University, Seligman Centre for Advanced Therapeutics, New York, NY, USA.

37 Department of Rheumatology, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada.

Abstract

OBJECTIVES:

To describe glucocorticoid (GC) use in the SLICC inception cohort and to explore factors associated with GC use. In particular we aimed to assess temporal trends in GC use and to what extent physician-related factors may influence use.

METHODS:

Patients were recruited within 15 months of diagnosis of SLE from 33 centres between 1999 and 2011 and continue to be reviewed annually. Descriptive statistics were used to detail oral and parenteral GC use. Cross sectional and longitudinal analyses were performed to explore factors associated with GC use at enrolment and over time.

RESULTS:

We studied 1700 patients with a mean (s.d.) follow-up duration of 7.26 (3.82) years. Over the entire study period, 1365 (81.3%) patients received oral GCs and 447 (26.3%) received parenteral GCs at some point. GC use was strongly associated with treatment centre, age, race/ethnicity, sex, disease duration and disease activity. There was no change in the proportion of patients on GCs or the average doses of GC used over time according to year of diagnosis.

CONCLUSION:

GCs remain a cornerstone in SLE management and there have been no significant changes in their use over the past 10-15 years. While patient and disease factors contribute to the variation in GC use, between-centre differences suggest that physician-related factors also contribute. Evidence-based treatment algorithms are needed to inform a more standardized approach to GC use in SLE.