Abstract：
OBJECTIVE: Multiple treatment options are recommended for Systemic Lupus Erythematosus (SLE) by clinical guidelines. This study aimed to explore SLE treatment patterns as there is limited real-world data of SLE medication utilisation, especially in childhood-onset SLE (cSLE).
METHODS: We conducted a longitudinal cohort study using five routinely collected healthcare databases from four European countries (United Kingdom, France, Germany, and Spain). We described the characteristics of adult and paediatric patients at time of SLE diagnosis. We calculated the percentage of patients commencing SLE treatments in the first month and year after diagnosis, reported number of prescriptions, starting dose, cumulative dose, and duration of each treatment, and characterised the line of therapy.
RESULTS: We characterised 11,255 patients with a first diagnosis of SLE and included 5718 in our medication utilisation analyses. The majority of adult SLE patients were female (range 80-88 %), with median age of 49 to 54 years at diagnosis. In the paediatric cohort (n = 378), 66-83 % of SLE patients were female, with median age of 12 to 16 years at diagnosis. Hydroxychloroquine and glucocorticoids were common first-line treatments in both adults and children, with second-line treatments including mycophenolate mofetil and methotrexate. Few cases of monoclonal antibody use were seen in either cohort. Initial glucocorticoid dosing in paediatric patients was often higher than in adults.
CONCLUSIONS: Treatment choices for adult SLE patients across four European countries were in line with recent therapeutic consensus guidelines. High glucocorticoid prescriptions in paediatric patients suggests the need for steroid-sparing treatment alternatives and paediatric specific guidelines.
METHODS: We conducted a longitudinal cohort study using five routinely collected healthcare databases from four European countries (United Kingdom, France, Germany, and Spain). We described the characteristics of adult and paediatric patients at time of SLE diagnosis. We calculated the percentage of patients commencing SLE treatments in the first month and year after diagnosis, reported number of prescriptions, starting dose, cumulative dose, and duration of each treatment, and characterised the line of therapy.
RESULTS: We characterised 11,255 patients with a first diagnosis of SLE and included 5718 in our medication utilisation analyses. The majority of adult SLE patients were female (range 80-88 %), with median age of 49 to 54 years at diagnosis. In the paediatric cohort (n = 378), 66-83 % of SLE patients were female, with median age of 12 to 16 years at diagnosis. Hydroxychloroquine and glucocorticoids were common first-line treatments in both adults and children, with second-line treatments including mycophenolate mofetil and methotrexate. Few cases of monoclonal antibody use were seen in either cohort. Initial glucocorticoid dosing in paediatric patients was often higher than in adults.
CONCLUSIONS: Treatment choices for adult SLE patients across four European countries were in line with recent therapeutic consensus guidelines. High glucocorticoid prescriptions in paediatric patients suggests the need for steroid-sparing treatment alternatives and paediatric specific guidelines.
摘要：
目的：临床指南推荐系统性红斑狼疮（SLE）的多种治疗方案。本研究旨在探索SLE治疗模式，因为SLE药物利用的真实数据有限，尤其是儿童期发病的SLE（cSLE）。
方法：我们使用来自四个欧洲国家（英国，法国,德国,和西班牙）。我们描述了SLE诊断时成人和儿科患者的特征。我们计算了诊断后第一个月和一年开始SLE治疗的患者百分比，报告的处方数量，起始剂量,累积剂量,和每次治疗的持续时间，并以治疗路线为特征。
结果：我们对11,255例首次诊断为SLE的患者进行了鉴定，并在我们的药物利用分析中纳入了5718例。大多数成人SLE患者是女性（范围80-88%），诊断时的中位年龄为49至54岁。在儿科队列中（n=378），66-83%的SLE患者是女性，诊断时的中位年龄为12至16岁。羟氯喹和糖皮质激素是成人和儿童常见的一线治疗方法。二线治疗包括霉酚酸酯和甲氨蝶呤。在任何一个队列中都很少看到使用单克隆抗体的病例。儿科患者的初始糖皮质激素剂量通常高于成人。
结论：四个欧洲国家的成人SLE患者的治疗选择符合最近的治疗共识指南。儿科患者的高糖皮质激素处方表明需要保留类固醇的治疗替代方案和儿科特定指南。
方法：我们使用来自四个欧洲国家（英国，法国,德国,和西班牙）。我们描述了SLE诊断时成人和儿科患者的特征。我们计算了诊断后第一个月和一年开始SLE治疗的患者百分比，报告的处方数量，起始剂量,累积剂量,和每次治疗的持续时间，并以治疗路线为特征。
结果：我们对11,255例首次诊断为SLE的患者进行了鉴定，并在我们的药物利用分析中纳入了5718例。大多数成人SLE患者是女性（范围80-88%），诊断时的中位年龄为49至54岁。在儿科队列中（n=378），66-83%的SLE患者是女性，诊断时的中位年龄为12至16岁。羟氯喹和糖皮质激素是成人和儿童常见的一线治疗方法。二线治疗包括霉酚酸酯和甲氨蝶呤。在任何一个队列中都很少看到使用单克隆抗体的病例。儿科患者的初始糖皮质激素剂量通常高于成人。
结论：四个欧洲国家的成人SLE患者的治疗选择符合最近的治疗共识指南。儿科患者的高糖皮质激素处方表明需要保留类固醇的治疗替代方案和儿科特定指南。
