Young patients with newly-diagnosed SLE report low immunosuppressant use in first year
Click Here to Manage Email Alerts
Prescription immunosuppressant use is low during the first year of care among young patients with newly diagnosed systemic lupus erythematosus, while hydroxychloroquine use is prevalent, although not universal, researchers report.
“Glucocorticoid-sparing immunomodulatory treatment is important to prevent major organ damage and help children reduce adverse effects of glucocorticoid exposure, including interference with growth and development,” Alaina Davis, MD, of the Monroe Carell Junior Children’s Hospital at Vanderbilt, in Nashville, and colleagues wrote in Arthritis Care & Research.
“Clinical trials demonstrate reduction of disease activity and overall morbidity with use of hydroxychloroquine and immunosuppressant medications,” they added. “The early severe disease activity and resulting rapid accrual of organ damage in youth with SLE make early effective immunomodulatory therapy important in this vulnerable population. Increased understanding of medication use early during the disease course could inform interventions to improve care for youth with SLE.”
To analyze the use of glucocorticoidsparing immunosuppressants among young patients with SLE during their first year of care, Davis and colleagues conducted a retrospective cohort study of data from Clinformatics DataMart, a database of private health insurance and Medicare
Advantage — plans C and D — claims. The database represents 15% to 20% of the commercially insured U.S. population and contains de-identified patient-level information, including demographics, medical diagnoses and health care use.
Focusing on the period from 2000 to 2013, Davis and colleagues identified 532 patients aged 10 to 24 years with a diagnosis of SLE for inclusion in their study. They calculated the proportion of patients who filled a prescription for immunosuppressant medication within 12 months of their first SLE code, their index date. The researchers then used multivariable regression to examine associations between demographic and disease factors and the time to a filled prescription in the first year, as well as a filled prescription at any time after the index date.
According to the researchers, 78% of included patients filled a prescription for a glucocorticoidsparing immunosuppressant drug during their first year of treatment. Overall, 69% of patients filled prescriptions for hydroxychloroquine and 34% filled prescriptions for immunosuppressants in the first year. Those with adultonset, compared with childhoodonset, disease were less likely to fill an immunosuppressant medication by 12 months.
“Use of glucocorticoid-sparing immunomodulatory medication among youth with newly diagnosed SLE is lower than evidence-based practice would suggest is desirable,” Davis wrote. “Further work is needed to better characterize physician prescribing practices and medication adherence in this population. This work will help identify factors contributing to suboptimal use and inform development of targeted interventions to improve health outcomes for youth with SLE.”
Collapse
Read more about
Click Here to Manage Email Alerts