Background/Purpose: Despite new developments in systemic lupus erythematosus (SLE) treatment and treatment guidelines, the clinical management of SLE is often sub-optimal. We aimed to describe the characteristics of SLE patients with suboptimal disease control in a large practice-based research rheumatology network using electronic health records (EHR) and linked claims data to identify those who could potentially benefit from treatment optimization.

Methods: We queried the data warehouse of Illumination Health, which includes data from the Excellence Network in Rheumatology (ENRGY) practice-based research network, from 1/2016-4/2024 including patients ≥18 years old, with ≥2 ICD10 codes beginning with M32.* (excluding M32.0) within 30-365 days, with ≥12 months of EHR data, and active in the rheumatology network in the 6 months prior to 4/30/2024. EHR data were linked with claims data from Komodo Health (Commercial, Medicare and Medicaid data from 1/2016 to 2/2024), requiring ≥12 months of continuous coverage in claims data for inclusion in this study. We defined suboptimal control as: (i) mean daily oral corticosteroid (OCS) treatment (measured in prednisone equivalent) of >5 mg according to EULAR guidelines for ≥8 weeks, or (ii) ≥2 hospitalizations and/or ≥2 emergency room (ER) visits in the most recent 12 months covered by claims data.

Results: We identified 5,564 eligible patients with SLE (Table). Patients were mostly female (92.6%), White (41.0%), 40-59 years old (50-59 years: 27.8%; 40-49 years: 23.4%), commercially insured (75.1%), and resided in the southern states of the U.S. (68.0%). Approximately 34.0% (1,888/5,564) of patients had sub-optimally controlled SLE, with 59.7% qualifying through OCS dose >5mg only, 22.5% through ≥2 hospitalizations or ≥2 ER visits only, and 17.9% through OCS dose and ER/hospitalizations. There was a greater proportion of Black or African American and Hispanic patients with SLE in the sub-optimally controlled versus not sub-optimally controlled cohort (21.6% vs. 15.3% and 17.0% vs. 15.1%, respectively). Similarly, a larger proportion of patients had Medicaid and Medicare coverage in the sub-optimally controlled cohort (6.4% vs. 3.8% and 23.5% vs. 18.4%, respectively).

Conclusion: Although there are recommendations to minimize the use of OCS in SLE management, utilization of high-dose OCS remains high, underscoring the importance of treatment optimization to improve disease control especially in African American and Hispanic populations.

« Back to ACR Convergence 2024

ACR Meeting Abstracts - https://acrabstracts.org/abstract/adherence-to-eular-recommendations-and-sub-optimal-management-of-systemic-lupus-erythematosus-in-a-network-of-community-based-rheumatology-practices-in-the-united-states/