Glucocorticoid use and factors associated with variability in this use in the Systemic Lupus International Collaborating Clinics Inception Cohort

Jayne Little; Ben Parker; Mark Lunt; John G Hanly; Murray B Urowitz; Ann E Clarke; Juanita Romero-Diaz; Caroline Gordon; Sang-Cheol Bae; Sasha Bernatsky; Daniel J Wallace; Joan T Merrill; Jill Buyon; David A Isenberg; Anisur Rahman; Ellen M Ginzler; Michelle Petri; Mary Anne Dooley; Paul Fortin; Dafna D Gladman; Kristjan Steinsson; Rosalind Ramsey-Goldman; Munther A Khamashta; Cynthia Aranow; Meggan Mackay; Graciela S Alarcón; Susan Manzi; Ola Nived; Andreas Jönsen; Asad A Zoma; Ronald F van Vollenhoven; Manuel Ramos-Casals; Guillermo Ruiz-Irastorza; Sung Sam Lim; Kenneth C Kalunian; Murat Inanc; Diane L Kamen; Christine A Peschken; Soren Jacobsen; Anca Askanase; Jorge Sanchez-Guerrero; Ian N Bruce

doi:10.1093/rheumatology/kex444

Glucocorticoid use and factors associated with variability in this use in the Systemic Lupus International Collaborating Clinics Inception Cohort

Jayne Little, Ben Parker, Mark Lunt, John G Hanly, Murray B Urowitz, Ann E Clarke, Juanita Romero-Diaz, Caroline Gordon, Sang-Cheol Bae, Sasha Bernatsky, Daniel J Wallace, Joan T Merrill, Jill Buyon, David A Isenberg, Anisur Rahman, Ellen M Ginzler, Michelle Petri, Mary Anne Dooley, Paul Fortin, Dafna D GladmanKristjan Steinsson, Rosalind Ramsey-Goldman, Munther A Khamashta, Cynthia Aranow, Meggan Mackay, Graciela S Alarcón, Susan Manzi, Ola Nived, Andreas Jönsen, Asad A Zoma, Ronald F van Vollenhoven, Manuel Ramos-Casals, Guillermo Ruiz-Irastorza, Sung Sam Lim, Kenneth C Kalunian, Murat Inanc, Diane L Kamen, Christine A Peschken, Soren Jacobsen, Anca Askanase, Jorge Sanchez-Guerrero, Ian N Bruce

Department of Clinical Medicine

16 Citations (Scopus)

Abstract

Objectives: To describe glucocorticoid (GC) use in the SLICC inception cohort and to explore factors associated with GC use. In particular we aimed to assess temporal trends in GC use and to what extent physician-related factors may influence use.

Methods: Patients were recruited within 15 months of diagnosis of SLE from 33 centres between 1999 and 2011 and continue to be reviewed annually. Descriptive statistics were used to detail oral and parenteral GC use. Cross sectional and longitudinal analyses were performed to explore factors associated with GC use at enrolment and over time.

Results: We studied 1700 patients with a mean (s.d.) follow-up duration of 7.26 (3.82) years. Over the entire study period, 1365 (81.3%) patients received oral GCs and 447 (26.3%) received parenteral GCs at some point. GC use was strongly associated with treatment centre, age, race/ethnicity, sex, disease duration and disease activity. There was no change in the proportion of patients on GCs or the average doses of GC used over time according to year of diagnosis.

Conclusion: GCs remain a cornerstone in SLE management and there have been no significant changes in their use over the past 10-15 years. While patient and disease factors contribute to the variation in GC use, between-centre differences suggest that physician-related factors also contribute. Evidence-based treatment algorithms are needed to inform a more standardized approach to GC use in SLE.

Original language	English
Journal	Rheumatology
Volume	57
Issue number	4
Pages (from-to)	677-687
ISSN	1462-0324
DOIs	https://doi.org/10.1093/rheumatology/kex444
Publication status	Published - 1 Apr 2018

Keywords

Adult
Algorithms
Asia/epidemiology
Cross-Sectional Studies
Disease Progression
Dose-Response Relationship, Drug
Drug Prescriptions/statistics & numerical data
Ethnic Groups
Europe/epidemiology
Female
Follow-Up Studies
Glucocorticoids/administration & dosage
Health Status
Humans
International Cooperation
Lupus Erythematosus, Systemic/drug therapy
Male
Morbidity/trends
North America/epidemiology
Retrospective Studies
Risk Factors
Severity of Illness Index
Time Factors
Young Adult

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Little, J., Parker, B., Lunt, M., Hanly, J. G., Urowitz, M. B., Clarke, A. E., Romero-Diaz, J., Gordon, C., Bae, S.-C., Bernatsky, S., Wallace, D. J., Merrill, J. T., Buyon, J., Isenberg, D. A., Rahman, A., Ginzler, E. M., Petri, M., Dooley, M. A., Fortin, P., ... Bruce, I. N. (2018). Glucocorticoid use and factors associated with variability in this use in the Systemic Lupus International Collaborating Clinics Inception Cohort. Rheumatology, 57(4), 677-687. https://doi.org/10.1093/rheumatology/kex444

Little, J, Parker, B, Lunt, M, Hanly, JG, Urowitz, MB, Clarke, AE, Romero-Diaz, J, Gordon, C, Bae, S-C, Bernatsky, S, Wallace, DJ, Merrill, JT, Buyon, J, Isenberg, DA, Rahman, A, Ginzler, EM, Petri, M, Dooley, MA, Fortin, P, Gladman, DD, Steinsson, K, Ramsey-Goldman, R, Khamashta, MA, Aranow, C, Mackay, M, Alarcón, GS, Manzi, S, Nived, O, Jönsen, A, Zoma, AA, van Vollenhoven, RF, Ramos-Casals, M, Ruiz-Irastorza, G, Sam Lim, S, Kalunian, KC, Inanc, M, Kamen, DL, Peschken, CA, Jacobsen, S, Askanase, A, Sanchez-Guerrero, J & Bruce, IN 2018, 'Glucocorticoid use and factors associated with variability in this use in the Systemic Lupus International Collaborating Clinics Inception Cohort', Rheumatology, vol. 57, no. 4, pp. 677-687. https://doi.org/10.1093/rheumatology/kex444

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title = "Glucocorticoid use and factors associated with variability in this use in the Systemic Lupus International Collaborating Clinics Inception Cohort",

abstract = "Objectives: To describe glucocorticoid (GC) use in the SLICC inception cohort and to explore factors associated with GC use. In particular we aimed to assess temporal trends in GC use and to what extent physician-related factors may influence use.Methods: Patients were recruited within 15 months of diagnosis of SLE from 33 centres between 1999 and 2011 and continue to be reviewed annually. Descriptive statistics were used to detail oral and parenteral GC use. Cross sectional and longitudinal analyses were performed to explore factors associated with GC use at enrolment and over time.Results: We studied 1700 patients with a mean (s.d.) follow-up duration of 7.26 (3.82) years. Over the entire study period, 1365 (81.3%) patients received oral GCs and 447 (26.3%) received parenteral GCs at some point. GC use was strongly associated with treatment centre, age, race/ethnicity, sex, disease duration and disease activity. There was no change in the proportion of patients on GCs or the average doses of GC used over time according to year of diagnosis.Conclusion: GCs remain a cornerstone in SLE management and there have been no significant changes in their use over the past 10-15 years. While patient and disease factors contribute to the variation in GC use, between-centre differences suggest that physician-related factors also contribute. Evidence-based treatment algorithms are needed to inform a more standardized approach to GC use in SLE.",

keywords = "Adult, Algorithms, Asia/epidemiology, Cross-Sectional Studies, Disease Progression, Dose-Response Relationship, Drug, Drug Prescriptions/statistics & numerical data, Ethnic Groups, Europe/epidemiology, Female, Follow-Up Studies, Glucocorticoids/administration & dosage, Health Status, Humans, International Cooperation, Lupus Erythematosus, Systemic/drug therapy, Male, Morbidity/trends, North America/epidemiology, Retrospective Studies, Risk Factors, Severity of Illness Index, Time Factors, Young Adult",

author = "Jayne Little and Ben Parker and Mark Lunt and Hanly, {John G} and Urowitz, {Murray B} and Clarke, {Ann E} and Juanita Romero-Diaz and Caroline Gordon and Sang-Cheol Bae and Sasha Bernatsky and Wallace, {Daniel J} and Merrill, {Joan T} and Jill Buyon and Isenberg, {David A} and Anisur Rahman and Ginzler, {Ellen M} and Michelle Petri and Dooley, {Mary Anne} and Paul Fortin and Gladman, {Dafna D} and Kristjan Steinsson and Rosalind Ramsey-Goldman and Khamashta, {Munther A} and Cynthia Aranow and Meggan Mackay and Alarc{\'o}n, {Graciela S} and Susan Manzi and Ola Nived and Andreas J{\"o}nsen and Zoma, {Asad A} and {van Vollenhoven}, {Ronald F} and Manuel Ramos-Casals and Guillermo Ruiz-Irastorza and {Sam Lim}, Sung and Kalunian, {Kenneth C} and Murat Inanc and Kamen, {Diane L} and Peschken, {Christine A} and Soren Jacobsen and Anca Askanase and Jorge Sanchez-Guerrero and Bruce, {Ian N}",

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doi = "10.1093/rheumatology/kex444",

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T1 - Glucocorticoid use and factors associated with variability in this use in the Systemic Lupus International Collaborating Clinics Inception Cohort

AU - Little, Jayne

AU - Parker, Ben

AU - Lunt, Mark

AU - Hanly, John G

AU - Urowitz, Murray B

AU - Clarke, Ann E

AU - Romero-Diaz, Juanita

AU - Gordon, Caroline

AU - Bae, Sang-Cheol

AU - Bernatsky, Sasha

AU - Wallace, Daniel J

AU - Merrill, Joan T

AU - Buyon, Jill

AU - Isenberg, David A

AU - Rahman, Anisur

AU - Ginzler, Ellen M

AU - Petri, Michelle

AU - Dooley, Mary Anne

AU - Fortin, Paul

AU - Gladman, Dafna D

AU - Steinsson, Kristjan

AU - Ramsey-Goldman, Rosalind

AU - Khamashta, Munther A

AU - Aranow, Cynthia

AU - Mackay, Meggan

AU - Alarcón, Graciela S

AU - Manzi, Susan

AU - Nived, Ola

AU - Jönsen, Andreas

AU - Zoma, Asad A

AU - van Vollenhoven, Ronald F

AU - Ramos-Casals, Manuel

AU - Ruiz-Irastorza, Guillermo

AU - Sam Lim, Sung

AU - Kalunian, Kenneth C

AU - Inanc, Murat

AU - Kamen, Diane L

AU - Peschken, Christine A

AU - Jacobsen, Soren

AU - Askanase, Anca

AU - Sanchez-Guerrero, Jorge

AU - Bruce, Ian N

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Objectives: To describe glucocorticoid (GC) use in the SLICC inception cohort and to explore factors associated with GC use. In particular we aimed to assess temporal trends in GC use and to what extent physician-related factors may influence use.Methods: Patients were recruited within 15 months of diagnosis of SLE from 33 centres between 1999 and 2011 and continue to be reviewed annually. Descriptive statistics were used to detail oral and parenteral GC use. Cross sectional and longitudinal analyses were performed to explore factors associated with GC use at enrolment and over time.Results: We studied 1700 patients with a mean (s.d.) follow-up duration of 7.26 (3.82) years. Over the entire study period, 1365 (81.3%) patients received oral GCs and 447 (26.3%) received parenteral GCs at some point. GC use was strongly associated with treatment centre, age, race/ethnicity, sex, disease duration and disease activity. There was no change in the proportion of patients on GCs or the average doses of GC used over time according to year of diagnosis.Conclusion: GCs remain a cornerstone in SLE management and there have been no significant changes in their use over the past 10-15 years. While patient and disease factors contribute to the variation in GC use, between-centre differences suggest that physician-related factors also contribute. Evidence-based treatment algorithms are needed to inform a more standardized approach to GC use in SLE.

AB - Objectives: To describe glucocorticoid (GC) use in the SLICC inception cohort and to explore factors associated with GC use. In particular we aimed to assess temporal trends in GC use and to what extent physician-related factors may influence use.Methods: Patients were recruited within 15 months of diagnosis of SLE from 33 centres between 1999 and 2011 and continue to be reviewed annually. Descriptive statistics were used to detail oral and parenteral GC use. Cross sectional and longitudinal analyses were performed to explore factors associated with GC use at enrolment and over time.Results: We studied 1700 patients with a mean (s.d.) follow-up duration of 7.26 (3.82) years. Over the entire study period, 1365 (81.3%) patients received oral GCs and 447 (26.3%) received parenteral GCs at some point. GC use was strongly associated with treatment centre, age, race/ethnicity, sex, disease duration and disease activity. There was no change in the proportion of patients on GCs or the average doses of GC used over time according to year of diagnosis.Conclusion: GCs remain a cornerstone in SLE management and there have been no significant changes in their use over the past 10-15 years. While patient and disease factors contribute to the variation in GC use, between-centre differences suggest that physician-related factors also contribute. Evidence-based treatment algorithms are needed to inform a more standardized approach to GC use in SLE.

KW - Adult

KW - Algorithms

KW - Asia/epidemiology

KW - Cross-Sectional Studies

KW - Disease Progression

KW - Dose-Response Relationship, Drug

KW - Drug Prescriptions/statistics & numerical data

KW - Ethnic Groups

KW - Europe/epidemiology

KW - Female

KW - Follow-Up Studies

KW - Glucocorticoids/administration & dosage

KW - Health Status

KW - Humans

KW - International Cooperation

KW - Lupus Erythematosus, Systemic/drug therapy

KW - Male

KW - Morbidity/trends

KW - North America/epidemiology

KW - Retrospective Studies

KW - Risk Factors

KW - Severity of Illness Index

KW - Time Factors

KW - Young Adult

U2 - 10.1093/rheumatology/kex444

DO - 10.1093/rheumatology/kex444

M3 - Journal article

C2 - 29361147

SN - 1462-0324

VL - 57

SP - 677

EP - 687

JO - Rheumatology

JF - Rheumatology

IS - 4

ER -

Glucocorticoid use and factors associated with variability in this use in the Systemic Lupus International Collaborating Clinics Inception Cohort

Abstract

Keywords

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