You are here

Article Text

Article menu

Download PDFPDF

Poster Presentations
P152 Exploring global discrepancies in systemic lupus erythematosus treatment
  1. Eman Elfar1,
  2. Gagandeep Sukhija1,
  3. Amelia Holloway1,
  4. Sook Yan Lee1,
  5. Elena Nikiphorou1,2,
  6. Ioannis Parodi3,4,
  7. Naveen R5,
  8. Jessica Day6,7,8,
  9. Mrudula Joshi9,
  10. Sreoshy Saha10,
  11. Syahrul Sazliyana Shaharir11,
  12. Wanruchada Katchamart12,
  13. Phonpen Akawatcharangura Goo13,
  14. Lisa S Traboco14,
  15. Yi Ming Chen15,16,
  16. Parikshit Sen17,
  17. James B Lilleker18,19,
  18. Arvind Nune20,
  19. John D Pauling21,22,
  20. Ai Lyn Tan23,24,
  21. Nelly Ziade25,26,
  22. Marcin Milchert27,
  23. Abraham Edgar Gracia-Ramos28,
  24. Carlo Vinicio Caballero-Uribe29,
  25. COVAD Study Group Vikas Agarwal30,
  26. Rohit Aggarwal31,
  27. Latika Gupta32,33 and
  28. Chris Wincup1,2
  1. 1Rheumatology Dept., King’s College Hospital, London, UK
  2. 2Centre for Rheumatic Diseases, King’s College London, London, UK
  3. 3Division of Rheumatology, Dept. of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
  4. 4Dept. of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
  5. 5Dept. of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
  6. 6Dept. of Rheumatology, Royal Melbourne Hospital, Parkville, Australia
  7. 7Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
  8. 8Dept. of Medical Biology, University of Melbourne, Parkville, Australia
  9. 9Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India
  10. 10Mymensingh Medical College, Mymensingh, Bangladesh
  11. 11Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur
  12. 12Division of Rheumatology, Dept. of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  13. 13Dept. of Medicine, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand
  14. 14Dept. of Medicine, Section of Rheumatology, St. Luke’s Medical Center-Global City, Taguig, Philippines
  15. 15Division of Allergy, Immunology and Rheumatology, Dept. of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
  16. 16Dept. of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
  17. 17Maulana Azad Medical College, 2-Bahadurshah Zafar Marg, New Delhi, India
  18. 18Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
  19. 19Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
  20. 20Southport and Ormskirk Hospital NHS Trust, Southport, UK
  21. 21Bristol Medical School Translational Health Sciences, University of Bristol, UK
  22. 22Dept. of Rheumatology, North Bristol NHS Trust, Bristol, UK
  23. 23NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK
  24. 24Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
  25. 25Rheumatology Dept., Saint-Joseph University, Beirut, Lebanon
  26. 26Rheumatology Dept., Hotel-Dieu de France Hospital, Beirut, Lebanon
  27. 27Dept. of Internal Medicine, Rheumatology, Diabetology, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Poland
  28. 28Dept. of Internal Medicine, General Hospital, National Medical Center ‘La Raza’, Instituto Mexicano del Seguro Social, Mexico City, Mexico
  29. 29Dept. of Medicine, Hospital Universidad del Norte, Barranquilla, Atlantico, Colombia
  30. 30Dept. of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, India
  31. 31Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
  32. 32Dept. of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
  33. 33City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK

Abstract

Objective Globally, there is an absence of standardised protocols for the treatment of SLE. This study aimed to conduct a worldwide evaluation of treatment, including the use of steroids, conventional DMARDs and biologic agents in SLE. Additionally, we sought to explore the impact of the Human Development Index (HDI) on regional variations in therapy.

Methods Data from the COVID-19 database including patient demographics and treatments was grouped by continent. Data collection included demographics and current treatment including; corticosteroids (CS), antimalarials, conventional DMARDs, cyclophosphamide and biologics (rituximab and belimumab). Analysis of treatment variations across regions was assessed by individual country HDI, a composite index formulated by the United Nations to rank countries into tiers of development. Statistical analysis comprised of Chi square for categorical values and t-test for comparison between groups.

Results The study included 1292 patients across six continents, with Asia and Europe having higher enrolment. Demographic details and treatment are summarised in table 1. Prescribing patterns are summarised in figure 1. Europe and North America showed lower steroid usage. Hydroxychloroquine was globally prevalent for SLE treatment, however was lowest in Europe (53%) and highest in Oceania (80%). Tacrolimus usage was significantly higher in South America, along with increased use of Mycophenolate. Azathioprine was more frequently used in North America and Africa. Cyclophosphamide was notably utilised more frequently in Asia (3%) and South America (3%). Rituximab use was lower in Europe compared to Africa and South America, whilst Belimumab was not administered to patients in Asia and Africa included in the study. When evaluating HDI, Hydroxychloroquine use was more often used in patients from low/medium HDI than in those from high/very high HDI (81% vs 68%, p=0.002). Similarly, conventional DMARDs were more commonly used in low/medium HDI than high/very high HDI (68% vs 56%, p=0.0009). In comparison, biologic use was more frequent in high/very high HDI countries (7% vs 2%, p=0.005).

Conclusions This study highlights significant regional treatment differences both globally and within continents when evaluating HDI. Further analysis is required to better understand the factors associated with choice of therapeutic agents at regional and continental level.

View this table:
Abstract P152 Table 1

Summary demographic and treatment details by continent

Abstract P152 Figure 1
Abstract P152 Figure 1

Frequency of individual therapies and steroid dose across continents

Declaration of Interest ALT has received honoraria for advisory boards and speaking for Abbvie, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB. EN has received speaker honoraria/participated in advisory boards for Celltrion, Pfizer, Sanofi, Gilead, Galapagos, AbbVie, and Lilly, and holds research grants from Pfizer and Lilly.

IP has received research funding and/or honoraria from Amgen, AstraZeneca, Aurinia Pharmaceuticals, Elli Lilly and Company, Gilead Sciences, GlaxoSmithKline, Janssen Pharmaceuticals, Novartis and F. Hoffmann-La Roche AG. JBL has received speaker honoraria/participated in advisory boards for Sanofi Genzyme, Roche, and Biogen. None is related to this manuscript. JD has received research funding from CSL Limited. NZ has received speaker fees, advisory board fees, and research grants from Pfizer, Roche, Abbvie, Eli Lilly, NewBridge, Sanofi-Aventis, Boehringer Ingelheim, Janssen, and Pierre Fabre; none are related to this manuscript. RA has a consultancy relationship with and/or has received research funding from the following companies: Bristol Myers-Squibb, Pfizer, Genentech, Octapharma, CSL Behring, Mallinckrodt, AstraZeneca, Corbus, Kezar, Abbvie, Janssen, Kyverna Alexion, Argenx, Q32, EMD-Serono, Boehringer Ingelheim, Roivant, Merck, Galapagos, Actigraph, Scipher, Horizon Therapeutics, Teva, Beigene, ANI Pharmaceuticals, Biogen, Nuvig, Capella Bioscience, and CabalettaBio. Rest of the authors have no conflict of interest relevant to this manuscript.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/lupus-2024-el.206

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.