Background/Purpose: Currently, there is not a standard treatment algorithm for the management of Systemic Lupus Erythematosus (SLE); however, there are medications that may be considered standard of care (SOC) for the treatment of SLE. Treatment may vary among patients depending on disease activity, presenting signs and symptoms, extent of organ involvement and access to care. Thus, there is a need to understand the range of treatment patterns in SLE patients.

Methods: The MarketScan^®Commercial Claims and Encounters and Medicare Supplemental Databases from Truven Health Analytics were used to retrospectively analyze SLE patients newly initiating SOC treatment (i.e., antimalarials, glucocorticoids, immunosuppressants, and monoclonal antibodies). Demographic and clinical characteristics, treatment patterns (e.g., augmentation, switching, and discontinuation), all-cause healthcare resource utilization and costs (i.e., sum of patient-paid out-of-pocket costs and plan-paid amounts) were examined in the 12 months following initiation of SLE SOC treatment (index date). Included were adult SLE patients who had ≥1 prescription claim for an SLE SOC treatment between January 2008 and December 2011 (without prior SOC treatment) and continuous medical and prescription coverage ≥12 months prior to and ≥12 months following the index date.

Results: There were 8,098 patients included in the study. Mean age of the cohort was 49 (± 13.8) years, 88.3% were female, and 12.1% were insured by Medicare. Most patients (98.7%) had ≥1 comorbidity; the most frequent comorbidities in the pre-index period were hypertension (32.6%) and anemia (13.9%). At index, 26.6%, 64.0%, 2.9%, and 0.2% of patients initiated treatment with antimalarials, glucocorticoids, immunosuppressants, or monoclonal antibodies, respectively, compared to 56.6%, 63.8%, 20.3%, and 1.1% during the 12-month post-index period. At index, 6.3% of patients initiated on some combination of the classes. During the 12-month post-index period, the index medication class was discontinued by 0.5%, 29.2%, 6.8%, and 84.2% of those who received antimalarials, glucocorticoids, immunosuppressants, and monoclonal antibodies, respectively, and 24%, 31%, 26%, and 5% added another SLE SOC class, respectively. The percentages of patients who switched from the index SOC class to a different SOC class were low, ranging from 0.0% to 5.3% among index therapies. During the 12-month follow-up period, almost all patients incurred outpatient visits (99%) and laboratory and radiology services (98%). Also, 21% of patients had an inpatient admission and 40% had an emergency room visit. The mean total healthcare cost was $24,575 during the 12-month follow-up period, including $8,329 inpatient, $13,069 outpatient, and $679 in SLE-related medication costs.

Conclusion: This analysis reveals the wide range of treatment patterns and substantial healthcare resource utilization and costs in SLE patients newly initiating SOC treatment. Understanding these treatment patterns in the context of associated disease activity, symptoms, and organ involvement may assist clinicians and payers in evaluating current and future therapies in the treatment of SLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/treatment-patterns-and-resource-utilization-of-systemic-lupus-erythematosus-patients-newly-initiating-standard-of-care-united-states-commercial-and-medicare-supplemental-claims-analysis/