Background/Purpose:

Current SLE treatment regimens follow an ‘add-on’ paradigm: typically, therapies are added as the activity of a patient’s disease increases. Most current treatments, particularly corticosteroids (CS) and immunosuppressants (IM), frequently have severe side effects that contribute to damage in SLE. This abstract reports an analysis of data drawn from a cross-sectional survey of physicians and their consulting lupus patients.

Methods:

Data were extracted from the Adelphi Real World Lupus Disease-Specific Programme (DSP), a cross-sectional survey of 233 physicians and their patients conducted between December 2009 and May 2010 in the USA, France, Germany, Italy, Spain, and the UK. Each physician completed a comprehensive patient record form for their five most recently seen SLE patients. Data collected included subjective rating of disease activity, flare occurrence, treatment satisfaction, and drug classes received. Patients were invited to fill out a self-completion questionnaire, which included EQ5D and the FACIT fatigue scale. This analysis focused on three key drug classes: CS, IM, and antimalarials (AM).

Results:

The Adelphi Lupus DSP survey included 886 patients, of whom 515 completed a self-assessment questionnaire. The population was 90% female with a mean age of 42 years. A total of 618 patients (70%) were classified as having mild disease activity, compared to 247 (28%) with moderate disease activity, and 21 (2%) with severe disease activity. The numbers of patients in each disease activity group flaring in the last 12 months were 138 (22.3%), 126 (51.0%), and 12 (57.1%), respectively. The proportions of patients receiving different regimens are listed in the table. SLE treatment regimens including CS (with or without other classes) were associated with more active disease (p < 0.0001) as were regimens that included ≥ 2 drug classes (p < 0.001). Patients reporting flares were more likely to be receiving ≥ 2 vs < 2 key drug classes (p < 0.001). A greater proportion of patients reported satisfaction with their treatment regimen when it did not include CS than when it did (81% vs 68%; p < 0.01). Patients receiving CS reported lower mean EQ5D than those who were not (0.731 vs 0.792; p = 0.0002). However, those receiving CS did report better fatigue levels than those who were not (35.0 vs 38.4, p = 0.0001). A greater proportion of physicians also reported more satisfaction with their patient's treatment regimen when it did not include CS (p < 0.001).

Conclusion:

More active disease is associated with flare in the last 12 months, ≥ 2 classes of therapy, and use of CS specifically. Unexpectedly, physicians and patients accepted moderate or high levels of disease activity while receiving multiple medications, suggesting that they had become resigned to uncontrolled disease activity. These results support the need for new therapies for SLE, and treatment algorithms incorporating such therapies.