番茄社区

Among young people with systemic lupus erythematosus (SLE), hydroxychloroquine use was widespread but not universal and overall prescription immunosuppressant use was low in the first year following diagnosis.

That's according to research published in .

The retrospective cohort study used administrative claims from 2000-2013 for youth ages 10-24 years with a new SLE diagnosis. Researchers ultimately identified 532 youth, of whom 413 (78%) had filled a glucocorticoid-sparing immunomodulatory prescription within the first year following diagnosis.

Prescriptions for hydroxychloroquine and immunosuppressants were filled in the first year, respectively, by 366 (69%) and 182 (34%) patients in the study. People with adult-onset disease were less likely than those with childhood-onset SLE to fill an immunomodulatory medication by the 12-month mark.

Alaina Davis, MD, MPH, a pediatric rheumatologist and researcher with Vanderbilt University Medical Center in Tennessee, served as first author of the study. She recently discussed the study and its findings with 番茄社区. The exchange has been edited for length and clarity.

What was the key knowledge gap your report was designed to address?

Davis: Youth with SLE are at high risk for early onset of major organ involvement and damage due to disease activity and glucocorticoid treatment. Increased understanding of immunomodulatory medication use early in the disease course could inform interventions to improve health outcomes for this vulnerable population.

Our study examined glucocorticoid-sparing immunomodulatory treatment patterns in the first year of care for youth with SLE.

How would you summarize your findings?

Davis: We found among these young people, hydroxychloroquine use and prescription immunosuppressant use is low during the first year of care.

Specifically, we found that only 55% of the cohort filled a prescription for hydroxychloroquine in the first three months after diagnosis, and only 69% obtained this medication by one year.

In addition, we found that only 16% of the study cohort filled a prescription for an immunosuppressant in the first three months after diagnosis, and only 34% did so within the first year.

Did anything surprise you in the results?

Davis: I was surprised that while hydroxychloroquine use is prevalent, it is not universal.

Hydroxychloroquine has been shown to prevent organ damage and potentially decrease morbidity. Its use is endorsed by international multispecialty groups and it is recommended for virtually all patients with SLE.

What are some potential factors behind the low usage level of these medications in this population?

Davis: The low rate of immunomodulatory use could be due to suboptimal physician treatment practices and/or poor patient adherence to filling prescribed medication.

Encouragingly, our study found that an increasing year of index date was independently associated with both decreased time to fill and increased odds of fill within the first year of diagnosis. This finding may reflect increasing uptake of evidence for immunomodulatory treatment effectiveness during the study.

In regard to medication adherence, prior studies have demonstrated poor rates in the SLE population. Most studies report that more than half of patients with SLE are nonadherent to prescribed treatment; specific rates presumably vary by cohort characteristics and method of adherence measurement.

What do you see as the study's takeaway message?

Davis: Our findings suggest that interventions to increase prescription fills for youth with SLE during the first year following diagnosis would be merited. Further research should focus on identifying factors associated with decreased prescription use in youth with SLE, especially potentially modifiable factors relating to medication nonadherence.

Read the study here and expert commentary on the clinical implications here.