The 2020 Pediatric Rheumatology Symposium, originally scheduled for April 29 – May 2, was postponed due to COVID-19; therefore, abstracts were not presented as scheduled.
Session Type: ACR Abstract Session
Session Time: 4:15PM-5:15PM
Background/Purpose: Background: Immunosuppressive therapy is the mainstay of treatment of child systemic lupus erythematosus (cSLE). However until very recently, the treatment of cSLE lacked uniformity. The treatment recommendation of cSLE was reported by the SHARE study from Europe in 2017. And in Japan, the Ministry of Health, Labor and Welfare study group published clinical practice guidelines of cSLE in 2018. These recommendations/guidelines have been contributed to standardization of cSLE treatment. We evaluated the trends in medication usage and how treatment choices have changed over time.
Methods: Methods: Using the Japanese health insurance database provided by Medical Data Vision Co., Ltd, we identified juvenile patients (under 18 years old) with at least one hospitalization, and SLE or lupus nephritis diagnostic code, and one prescription for any immunosuppressants or glucocorticoid recorded between January 2008 and June 2018. We divided these 11 years into two-year periods and evaluated changes over time of frequency of each medication usage, daily maximum dose of prednisolone (PSL), medication usage for common complications, and numbers and duration of hospitalizations.
Results: Results: Of 182 cSLE patients, 86% were female, and median age was 14 years old. There was a total of 437 hospitalizations in 182 patients, with median number of hospitalizations of 1 for each patient. The median duration of each hospital stay was 17 days in 2010 and 12 days in 2016, which was not significantly different. Intravenous methyl-PSL pulse therapy was used in 36-53% of cSLE patients over the study period. Oral PSL was the primary therapy used by more than 95% of cSLE patients, but the median of maximum daily oral PSL dose of each patient was decreased over time, 50mg/day in 2012 and 30mg/day in 2016 (P=0.03). Intravenous cyclophosphamide (IVCY) was used less frequently in 2016 and onward compared to before 2016 (4% vs.13%). Mizoribine usage was also decreased in 2012 and onward (39% before 2012, 13% after 2012). While mycophenolate mofetil (MMF) (50%) and hydroxychloroquine (31%) were frequently used in patients after the approval for cSLE in 2016 in Japan. Rituximab and belimumab usage was very limited. There were no significant differences over time in choice and frequency of anti-osteoporosis drugs. The frequency of antiviral drugs usage for varicella-zoster virus infection was around 10% which did not change over time.
Conclusion: Conclusions: This descriptive study provided data of medications received by a large number of cSLE patients using a health insurance database in recent 10 years. Our results showed that oral PSL was mainstay of treatment for cSLE. The most frequently prescribed immunosuppressive therapy shifted from IVCY to MMF over time. The maximum daily oral PSL dose was decreased over the past decade.
To cite this abstract in AMA style:Kishi T, Miyamae T, Sakai R, Tani Y, Nagata S, Harigai M. Actual Medication Usage of Patients with Juvenile Onset Systemic Lupus Erythematosus Using Japanese Health Insurance Database [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 4). https://acrabstracts.org/abstract/actual-medication-usage-of-patients-with-juvenile-onset-systemic-lupus-erythematosus-using-japanese-health-insurance-database/. Accessed January 23, 2022.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/actual-medication-usage-of-patients-with-juvenile-onset-systemic-lupus-erythematosus-using-japanese-health-insurance-database/