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

Jayne Little; Benjamin 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 P. Buyon; David A Isenberg; Anisur Rahman; Ellen M. Ginzler; Michelle Petri; M. A. Dooley; Paul Fortin; Dafna D Gladman; Kristjan Steinsson; Rosalind Ramsey-Goldman; Munther A Khamashta; Cynthia Aranow; Meggan  Mackay; Graciela S Alarcon; Susan Manzi; Ola Nived; Andreas  Jönsen; Asad A Zoma; Ronald F van Vollenhoven; Manuel Ramos-Casals; Guillermo Ruiz-Irastorza; S Sam Lim; Kenneth C Kalunian; Murat Inanc; Diane L Kamen; Christine A Peschken; Søren Jacobsen; Anca Askanase; Jorge Sanchez-Guerrero; Ian 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, Benjamin 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 P. Buyon, David A Isenberg, Anisur Rahman, Ellen M. Ginzler, Michelle Petri, M. A. Dooley, Paul Fortin, Dafna D GladmanKristjan Steinsson, Rosalind Ramsey-Goldman, Munther A Khamashta, Cynthia Aranow, Meggan Mackay, Graciela S Alarcon, Susan Manzi, Ola Nived, Andreas Jönsen, Asad A Zoma, Ronald F van Vollenhoven, Manuel Ramos-Casals, Guillermo Ruiz-Irastorza, S Sam Lim, Kenneth C Kalunian, Murat Inanc, Diane L Kamen, Christine A Peschken, Søren Jacobsen, Anca Askanase, Jorge Sanchez-Guerrero, Ian Bruce

Division of Musculoskeletal & Dermatological Sciences (L5)

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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
DOIs	https://doi.org/10.1093/rheumatology/kex444
Publication status	Published - 18 Jan 2018

Keywords

Systemic Lupus Erythematosus
Glucocorticoids
Epidemiology

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Little et al_Glucocorticoid use and factors associatedAccepted author manuscript, 460 KB

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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. P., Isenberg, D. A., Rahman, A., Ginzler, E. M., Petri, M., Dooley, M. A., Fortin, P., ... Bruce, I. (2018). Glucocorticoid use and factors associated with variability in this use in the Systemic Lupus International Collaborating Clinics Inception Cohort. Rheumatology. https://doi.org/10.1093/rheumatology/kex444

@article{d39295ce178e40ce85daa5abf4f2452f,

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

abstract = "ObjectivesTo 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.MethodsPatients 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.ResultsWe 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.ConclusionGCs 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 = "Systemic Lupus Erythematosus, Glucocorticoids , Epidemiology",

author = "Jayne Little and Benjamin 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 Buyon, {Jill P.} and Isenberg, {David A} and Anisur Rahman and Ginzler, {Ellen M.} and Michelle Petri and Dooley, {M. A.} 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 Alarcon, {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}, S and Kalunian, {Kenneth C} and Murat Inanc and Kamen, {Diane L} and Peschken, {Christine A} and S{\o}ren Jacobsen and Anca Askanase and Jorge Sanchez-Guerrero and Ian Bruce",

year = "2018",

month = jan,

day = "18",

doi = "10.1093/rheumatology/kex444",

language = "English",

journal = "Rheumatology",

issn = "1462-0324",

publisher = "Oxford University Press",

}

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, JP, 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, Alarcon, 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, I 2018, 'Glucocorticoid use and factors associated with variability in this use in the Systemic Lupus International Collaborating Clinics Inception Cohort', Rheumatology. https://doi.org/10.1093/rheumatology/kex444

TY - JOUR

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, Benjamin

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 P.

AU - Isenberg, David A

AU - Rahman, Anisur

AU - Ginzler, Ellen M.

AU - Petri, Michelle

AU - Dooley, M. A.

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 - Alarcon, 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, S

AU - Kalunian, Kenneth C

AU - Inanc, Murat

AU - Kamen, Diane L

AU - Peschken, Christine A

AU - Jacobsen, Søren

AU - Askanase, Anca

AU - Sanchez-Guerrero, Jorge

AU - Bruce, Ian

PY - 2018/1/18

Y1 - 2018/1/18

N2 - ObjectivesTo 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.MethodsPatients 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.ResultsWe 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.ConclusionGCs 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 - ObjectivesTo 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.MethodsPatients 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.ResultsWe 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.ConclusionGCs 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 - Systemic Lupus Erythematosus

KW - Glucocorticoids

KW - Epidemiology

U2 - 10.1093/rheumatology/kex444

DO - 10.1093/rheumatology/kex444

M3 - Article

SN - 1462-0324

JO - Rheumatology

JF - Rheumatology

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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