Corticosteroids and Hydroxychloriquine Top Medications Used by SLE, Lupus Nephritis Patients, Study Reports

Corticosteroids and hydroxychloroquine are the most common medications used by patients with systemic lupus erythematosus (SLE) or lupus nephritis (LN), according to a real-world study, which also found very limited use of biologics.

The study, “Real World Medication Use in Incident Systemic Lupus Erythematosus and Lupus Nephritis Patients,” was conducted by Janssen. It was presented Tuesday at the 2018 American College of Rheumatology (ACR)/Association for Rheumatology Health Professionals (ARHP) Annual Meeting in Chicago.

LN is a type of kidney inflammation that occurs in SLE patients. It is characterized by the gradual buildup of molecules called immune complexes, which trigger inflammation and may lead to irreversible fibrosis, or scarring.

More information is still needed regarding the standard of care for both SLE and LN. To look at real-world medication use among these patients, a research team conducted a retrospective study using data from two large administrative U.S. databases called Truven Health MarketScan and Optum. Information from the two databases was pooled together to identify adult patients with two or more medical claims on different dates for SLE or LN, diagnosed between January 2013 and December 2015.

Investigators analyzed the proportion of patients who used different types of SLE medications — such as biologics, corticosteroids, immunosuppressants, nonsteroidal anti-inflammatory drugs, or angiotensin-converting enzyme inhibitors — during the follow-up period, which was defined as one year after an initial diagnosis, as well as the average number of medical/prescription claims for each medication.

A total of 31,345 patients were identified. Of these, 30,086 had SLE (mean age of 52.7 years) and 1,259 had LN (mean age of 48.3 years). More than 80% of the patients were women.

The mean Charlson Comorbidity Index score — which predicts 10-year survival — was 1.1 for SLE patients and 1.8 for LN patients — predicting that 95% and 90% of these patients would live 10 years or more. The most frequent comorbidities, or coexisting conditions, at baseline were high blood pressure and infections.

The most frequently used SLE medications were corticosteroids, used by 58.3% of SLE patients (mean of 4.5 prescriptions) and 66.2% of LN patients (6.5 prescriptions), and the antimalarial therapy hydroxychloroquine, used by 43.4% of SLE patients (5.8 prescriptions) and 40.7% of LN patients (6.2 prescriptions).

Corticosteroids used included prednisone, betamethasone, budesonide, cortisone, desoxycorticosterone, dexamethasone, fludrocortisone, hydrocortisone, methylprednisolone, paramethasone, prednisolone, and triamcinolone

Only about 2% of patients used biologics, including GSK’s immunosuppressant Benlysta (belimumab), which was used by 1.1% of SLE patients (8.8 prescriptions) and 1.4% of LN patients (8.3 prescriptions), and the off-label lupus treatment Rituxan (rituximab), by Genentech/Biogen, used by 0.9% of SLE patients (4.2 prescriptions) and 2.1% of LN patients (four prescriptions).

“These data reveal an unmet need for availability of advanced therapy to treat SLE and LN. Future studies are warranted to understand the underlying [disease] causes,” the scientists wrote.

All study authors are employees at Janssen.