Real-world oral glucocorticoid use in SLE: a nation-wide population-based study using the French medico-administrative (SNDS) claim database.

Background: Oral glucocorticoids (OCS) remain one of the most important treatments for SLE but are associated with damage. Evidence regarding the real-world use of OCS in nationwide SLE populations is currently lacking. The aim of this study was to analyse OCS use and SLE treatments in French patients with SLE at the national level.

Methods: The nationwide French health insurance claims database, which contains pseudonymised data for ≈66 million people, was used. Prevalent patients with SLE (International Classification of Diseases, 10th Revision code M32, recorded as a chronic condition or associated with hospital stay) were identified over the year 2019. SLE treatments were captured through actual drug deliveries by pharmacies and mean daily OCS doses (prednisone equivalent) were calculated for the year 2019.

Results: The 2019 French prevalent SLE population comprised 31 852 patients (86.3% of women, with a mean age of 49.7 (±15.9) years) with a mean disease duration of 7.1 (±6.2) years. Among these, 48.3% were treated with OCS. The mean daily OCS dose was ≤5 mg/day in 35.9%, more than 5 mg but <7.5 mg/day in 6.4% and ≥7.5 mg/day in 6.0%. The use of other SLE treatments was significantly increased in patients with higher doses of OCS (p<0.0001). Potential complications of OCS, including cardiovascular diseases, infections and osteoporosis, were significantly increased in patients with SLE receiving more than 5 mg of OCS per day (p<0.0001, for all). Strikingly, 13.6% of patients receiving mean daily OCS doses >5 mg/day were not treated with antimalarial, immunosuppressant or biologic drugs for SLE.

Conclusions: In total, 48.2% of French patients with SLE were treated with OCS in 2019, including 12.4% at a mean dose >5 mg/day, with an increased risk of OCS complications and a limited use of antimalarials, immunosuppressants or biologics. These results highlight the urgent need for the implementation of more robust OCS-sparing strategies in SLE.