EXPLORING GLOBAL DISCREPANCIES IN SYSTEMIC LUPUS ERYTHEMATOSUS TREATMENT.
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All Authors
Elfar, E.
Sukhija G.
Holloway A.
Lee S.Y.
Nikiphorou E.
Parodi I.
Naveen R.
Day J.
Joshi M.
Saha S.
LTHT Author
Tan, Ai Lyn
LTHT Department
NIHR Leeds Biomedical Research Centre
Non Medic
Publication Date
2024
Item Type
Conference Abstract
Language
Subject
Subject Headings
Abstract
Objective Globally, there is an absence of standardised protocols for the treatment of SLE. This study aimed to conduct a worldwide evaluation of treatment, including the use of steroids, conventional DMARDs and biologic agents in SLE. Additionally, we sought to explore the impact of the Human Development Index (HDI) on regional variations in therapy. Methods Data from the COVID-19 database including patient demographics and treatments was grouped by continent. Data collection included demographics and current treatment including; corticosteroids (CS), antimalarials, conventional DMARDs, cyclophosphamide and biologics (rituximab and belimumab). Analysis of treatment variations across regions was assessed by individual country HDI, a composite index formulated by the United Nations to rank countries into tiers of development. Statistical analysis comprised of Chi square for categorical values and t-test for comparison between groups. Results The study included 1292 patients across six continents, with Asia and Europe having higher enrolment. Demographic details and treatment are summarised in table 1. Prescribing patterns are summarised in figure 1. Europe and North America showed lower steroid usage. Hydroxychloroquine was globally prevalent for SLE treatment, however was lowest in Europe (53%) and highest in Oceania (80%). Tacrolimus usage was significantly higher in South America, along with increased use of Mycophenolate. Azathioprine was more frequently used in North America and Africa. Cyclophosphamide was notably utilised more frequently in Asia (3%) and South America (3%). Rituximab use was lower in Europe compared to Africa and South America, whilst Belimumab was not administered to patients in Asia and Africa included in the study. When evaluating HDI, Hydroxychloroquine use was more often used in patients from low/medium HDI than in those from high/very high HDI (81% vs 68%, p=0.002). Similarly, conventional DMARDs were more commonly used in low/medium HDI than high/very high HDI (68% vs 56%, p=0.0009). In comparison, biologic use was more frequent in high/very high HDI countries (7% vs 2%, p=0.005). Conclusions This study highlights significant regional treatment differences both globally and within continents when evaluating HDI. Further analysis is required to better understand the factors associated with choice of therapeutic agents at regional and continental level.
Journal
Lupus Science and Medicine