Disease severity, comorbid conditions, treatment patterns, and flares in adults with systemic lupus erythematosus in the United Kingdom: a real-world observational retrospective cohort Analysis

Langham J, Barut V, Samnaliev M, Langham S, Weir S, Wang X, Desta B, Hammond ER. SAT0216 Disease severity, comorbid conditions, treatment patterns, and flares in adults with systemic lupus erythematosus in the United Kingdom: a real-world observational retrospective cohort AnalysisIS. Ann Rheum Dis 2020;79(Suppl 1):1050–1

Abstract

Background: There is limited real-world evidence describing the presentation and treatment patterns of systemic lupus erythematosus (SLE) in the United Kingdom (UK).

Objectives: To characterize disease severity, comorbid conditions, treatment patterns, and flares in a longitudinal cohort of adults with SLE in the UK.

Methods: Patients aged ≥18 years with SLE were identified in the Clinical Practice Research Datalink – Hospital Episode Statistics database from January 1, 2005, to December 31, 2017. Patients were required to have ≥12 months of data before and after index date (date of earliest SLE diagnosis available). SLE disease severity and flares were classified as mild, moderate, or severe using adapted claims-based algorithms1,2 that use SLE-related conditions (eg, end-stage renal disease), medications (eg, antimalarials, immunosuppressants, and corticosteroids), and health service use (eg, hospitalizations and emergency department visits).

Results: Of 802 patients with SLE, 369 (46.0%) had mild, 345 (43.0%) had moderate, and 88 (11.0%) had severe SLE at baseline. In total, 692 (86.3%) patients were treated with SLE medications in the first year after SLE diagnosis. Among the total population (802), 557 (69.5%) patients received antimalarials, 203 (25.3%) received immunosuppressants, and 416 (51.9%) received corticosteroids (prednisolone); patients may have received ≥1 type of drug. Information on biologic use in hospitals is unavailable in these data. The mean (standard deviation [SD]) time to initiating any medication from index date was 177 (385.3) days (Figure 1A). The median time to first flare from index date was 63 days (95% confidence interval 57–71) (Figure 1B). A majority of patients (750/802, 93.5%) experienced ≥1 flare during follow-up; the first flare was mild for 73.2% of patients (549/750), moderate for 15.5% (116/750), and severe for 11.3% (85/750). The mean (SD) annual overall flare rate in the first year after index date was 3.5 (2.5) (mild flares: 2.6 [2.5]; moderate flares: 0.7 [1.5]; severe flares: 0.2 [0.6]) (Figure 2). A shorter median time to first flare was significantly associated with moderate or severe disease (P<0.001) and the presence of comorbid conditions (P<0.001).

Conclusion: Our findings suggest some delay in SLE treatment initiation in the UK. Most patients with SLE experience flares within 2 months from diagnosis. Early treatment may delay or reduce the severity of the first SLE flare after diagnosis and may translate to slower disease progression, lower organ damage accrual, and better outcomes.