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Abstract
Objective It is unknown how patients with SLE are treated in real-life settings in European countries and to what extent treatment recommendations regarding the prescription of antimalarials and glucocorticoids (GC) have been incorporated into practice. We aimed to examine treatment patterns in the first 5 years after SLE diagnosis in Sweden, trends over time, and how it relates to patient characteristics.
Methods In a cohort of 4,226 patients with incident SLE between 2005 and 2021 identified from the Swedish National Patient Register, information on drug dispensations, hospitalizations, outpatient visits, and comorbidities was obtained through linkage to Swedish population registers. Treatment patterns, including combinations of antimalarials and GC cumulative dose, were investigated in relation to year of diagnosis, patient characteristics, and comorbidities, using intersection and alluvial plots, logistic regression and non-parametric methods.
Results Among patients in this cohort (83% females, mean age 48.7 ± 18.2) the proportion with antimalarials the first year after diagnosis increased from 50% in 2005–2008 to 81% in 2017–2021 (adj. p<.0001). In patients with at least 5 years of observation time (n=2717 diagnosis 2005–2016), an increase with calendar time was also seen 5 years after diagnosis (from 44% to 63%, adj. p<0.0001). While the proportion with GC during the first year remained at 68%, the proportion on CS at 5 years after diagnosis decreased somewhat over time (from 54% to 47%, adj. p=.005). In the group exposed to GC, the median average daily dose over the first 5 years decreased among males (from 5.5 mg to 4.3 mg, p=.014), but not to the same extent among females (from 3.8 mg to 3.5 mg, p=.27).
Conclusions In the five years after SLE diagnosis, use of antimalarials have, in accordance with recommendations, increased in Sweden from 2005 to 2021. Despite recommendations to use less GC, however, a decrease of the cumulative GC exposure over time is only seen for males and the effect of this decrease on clinical outcomes is of interest and should be further studied.
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