Objective To identify and characterize systemic lupus erythematosus (SLE) patients in Israel, treatment patterns, and the association between cumulative daily doses of corticosteroids (CS) and related comorbidities.

Methods A retrospective study using the computerized database of a large health maintenance organization. Prevalent SLE patients on Dec 31, 2020 were defined according to the following criteria: first SLE diagnosis at age ≥10 years; ≥1 purchase of hydroxychloroquine (HCQ); ≥1 positive anti-nuclear antibody test. Patients diagnosed with dermatomyositis or systemic sclerosis were excluded. Descriptive statistics were used to characterize SLE patients and treatment patterns. Multivariate logistic-regression models were used to assess the association between CS cumulative daily doses and comorbidities: osteoporosis, cardiovascular disease (CVD), hypertension, and diabetes mellitus. All models were adjusted for age, sex, socioeconomic status, smoking, and disease duration.

Results We identified 1073 SLE patients, corresponding to a SLE prevalence of 52.2 per 100,000 at the age of ≥12 years. Females constituted 87.7% (n=942), the mean age at disease onset was 37.23±14.36 years and the disease duration on Dec 31, 2020, was 12.89±6.23 years (table 1). Initiation of HCQ in the 12 months after SLE diagnosis increased from 51.0% in 2000, to 83.7% in 2010 and 93.0% in 2018. The annual uptake of HCQ during 2000–2020 ranged from 66.4% to 69.5%. The annual usage of CS gradually decreased from 45.3% in 2000, to 36.4% in 2010 and 30.8% in 2020. Moreover, the percentage of patients treated with CS at a mean dose of ≥7.5 mg/day of prednisone decreased from 11.5% in 2010 to 7.2% in 2020. Multivariable logistic regression models for the association between CS and comorbidities, including osteoporosis, diabetes mellitus, hypertension, and CVD demonstrated that compared to patients receiving a mean daily dose of less than 5 mg/day of prednisone, those receiving ≥5 mg/day, had a significantly increased odds for all comorbidities included (table 2). The results remained consistent when the analysis was restricted to those ever treated with CS.

Conclusions CS treatment in SLE patients in Israel is decreasing. The use of daily doses of prednisone exceeding 5 mg/day is associated with increased odds of osteoporosis, diabetes mellitus, hypertension, and CVD.

Acknowledgment The study was funded by Astra Zeneca. The company was not involved in the analysis of the data.