Background Corticosteroid (CS) use has been identified as a key factor associated with damage in SLE but detailed analyses of patterns of use in large international cohorts have not previously been reported.
Objectives To describe oral (PO) and parenteral CS use in a large international SLE cohort.
Methods The SLICC Inception Cohort recruited patients within 15 months of developing ≥4 1997 American College of Rheumatology (ACR) criteria for SLE, between 2000 and 2011. Details of PO and parenteral steroid use were captured at enrolment and each annual assessment, including type, dose and course dates. All CS data was converted to prednisolone equivalents and analysed using Stata 13.
Results 1848 patients have been recruited to the Cohort. Those with follow up data (1686) are included in this analysis, providing data on 10,572 annual follow-up (FU) intervals. The mean (SD) total FU is 6.72 (3.60) years; 1072 (63.5%) patients contributed ≥5 years FU; 343 (20.3%) contributed ≥10 years FU.
The proportion of time spent on PO CS can be calculated for 10,098 (95.5%) FU intervals. For the majority of FU intervals (n=9103 (90.1%)), NONE (4494 (44.5%)) or ALL (4609 (45.6%)) of the time was spent on PO CS. In 995 (9.9%) FU intervals, only a proportion of the time was spent on PO CS. In those FU intervals where PO CS have been received (n=5604) the median (IQR) “average daily PO dose” was 6.5 (4.75–10) mg. The average daily CS dose decreased in later FU intervals: median (IQR) at FU 1=10 (5–15) mg and at FU 5=5.5 (4.8–10.0) mg. 558 (34.7%) patients have been on PO CS for ALL of their time in the study, 720 (44.8%) for some of it and 330 (20.5%) have never been on PO CS.
228 patients (13.5%) received parenteral CS prior to and/or at enrolment at a median (IQR) total dose of 1.5 (0.5–3.0) g. CS pulses were given during 429 (4.37%) FU intervals at a median (IQR) total dose of 679.5 (120–2500) mg. This compares to a median (IQR) cumulative total PO dose between FUs of 2565 (1575–4462) mg. PO CS use between FUs (using various definitions - see table 1) was higher in those FU intervals in which pulsed CS have also been given.
Conclusions CS are widely prescribed in this international SLE cohort. 79.5% have been on CS at some point and 1 in 3 patients have taken CS throughout their entire disease duration. PO CS tend to be given at low daily doses for long periods of time but with a higher average daily dose earlier in the disease. Parenteral steroid use is associated with higher overall PO CS use, however PO CS contribute most to the total cumulative dose that patients receive. Current management of SLE still relies on CS use as a mainstay of therapy in a high proportion of patients.
Acknowledgement The Systemic Lupus International Collaborating Clinics (SLICC) acknowledge funding support of UCB Pharma for this study.
Disclosure of Interest None declared