• Mike Du, Francesco Dernie, Martí Català, Antonella Delmestri, Wai Yi Man, James T Brash, Hanne van Ballegooijen, Núria Mercadé-Besora, Talita Duarte-Salles, Miguel-Angel Mayer, Angela Leis, Juan Manuel Ramírez-Anguita, Romain Griffier, Guillaume Verdy, Albert Prats-Uribe, Alexandra Pacurariu, Daniel R Morales, Roberto De Lisa, Sara Galluzzo, Gunter F Egger, Daniel Prieto-Alhambra, and Eng Hooi Tan.
• Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
• Eur. J. Intern. Med. 2024 Aug 11.

ObjectiveMultiple 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).MethodsWe 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.ResultsWe 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.ConclusionTreatment 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.Copyright © 2024. Published by Elsevier B.V.

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