Glucocorticoid use and factors associated with variability in this use in the Systemic Lupus International Collaborating Clinics Inception Cohort

Jayne Little; Ben Parker; Mark Lunt; John G. Hanly; Murray B. Urowitz; Ann E. Clarke; Juanita Romero-Diaz; Caroline Gordon; Sang Cheol Bae; Sasha Bernatsky; Daniel J. Wallace; Joan T. Merrill; Jill Buyon; David A. Isenberg; Anisur Rahman; Ellen M. Ginzler; Michelle Petri; Mary Anne Dooley; Paul Fortin; Dafna D. Gladman; Kristjan Steinsson; Rosalind Ramsey-Goldman; Munther A. Khamashta; Cynthia Aranow; Meggan Mackay; Graciela S. Alarcón; Susan Manzi; Ola Nived; Andreas Jönsen; Asad A. Zoma; Ronald F. van Vollenhoven; Manuel Ramos-Casals; Guillermo Ruiz-Irastorza; Sung Sam Lim; Kenneth C. Kalunian; Murat Inanc; Diane L. Kamen; Christine A. Peschken; Soren Jacobsen; Anca Askanase; Jorge Sanchez-Guerrero; Ian N. Bruce

doi:10.1093/rheumatology/kex444

Glucocorticoid use and factors associated with variability in this use in the Systemic Lupus International Collaborating Clinics Inception Cohort

Jayne Little, Ben Parker, Mark Lunt, John G. Hanly, Murray B. Urowitz, Ann E. Clarke, Juanita Romero-Diaz, Caroline Gordon, Sang Cheol Bae, Sasha Bernatsky, Daniel J. Wallace, Joan T. Merrill, Jill Buyon, David A. Isenberg, Anisur Rahman, Ellen M. Ginzler, Michelle Petri, Mary Anne Dooley, Paul Fortin, Dafna D. GladmanKristjan Steinsson, Rosalind Ramsey-Goldman, Munther A. Khamashta, Cynthia Aranow, Meggan Mackay, Graciela S. Alarcón, Susan Manzi, Ola Nived, Andreas Jönsen, Asad A. Zoma, Ronald F. van Vollenhoven, Manuel Ramos-Casals, Guillermo Ruiz-Irastorza, Sung Sam Lim, Kenneth C. Kalunian, Murat Inanc, Diane L. Kamen, Christine A. Peschken, Soren Jacobsen, Anca Askanase, Jorge Sanchez-Guerrero, Ian N. Bruce^*

^*Corresponding author for this work

Medicine, Rheumatology Division

Research output: Contribution to journal › Article › peer-review

47 Scopus citations

Abstract

Objectives. To describe glucocorticoid (GC) use in the SLICC inception cohort and to explore factors associated with GC use. In particular we aimed to assess temporal trends in GC use and to what extent physician-related factors may influence use. Methods. Patients were recruited within 15 months of diagnosis of SLE from 33 centres between 1999 and 2011 and continue to be reviewed annually. Descriptive statistics were used to detail oral and parenteral GC use. Cross sectional and longitudinal analyses were performed to explore factors associated with GC use at enrolment and over time. Results. We studied 1700 patients with a mean (S.D.) follow-up duration of 7.26 (3.82) years. Over the entire study period, 1365 (81.3%) patients received oral GCs and 447 (26.3%) received parenteral GCs at some point. GC use was strongly associated with treatment centre, age, race/ethnicity, sex, disease duration and disease activity. There was no change in the proportion of patients on GCs or the average doses of GC used over time according to year of diagnosis. Conclusion. GCs remain a cornerstone in SLE management and there have been no significant changes in their use over the past 10-15 years. While patient and disease factors contribute to the variation in GC use, between-centre differences suggest that physician-related factors also contribute. Evidence-based treatment algorithms are needed to inform a more standardized approach to GC use in SLE.

Original language	English (US)
Pages (from-to)	677-687
Number of pages	11
Journal	Rheumatology (United Kingdom)
Volume	57
Issue number	4
DOIs	https://doi.org/10.1093/rheumatology/kex444
State	Published - Apr 1 2018

Funding

This study was funded by an unrestricted grant from UCB Pharma.A.E.C. holds The Arthritis Society Research Chair in Rheumatic Diseases at the University of Calgary. J.G.H.'s work was supported by the Canadian Institutes of Health Research (research grant MOP-88526). C.G.'s work was supported by Lupus UK, Sandwell and West Birmingham Hospitals NHS Trust and the National Institute for Health Research (NIHR)/Wellcome Trust Clinical Research Facility in Birmingham. S.-C.B.'s work was supported by unrestricted grant (Hanyang University 201600000001387). The Montreal General Hospital Lupus Clinic is partially supported by the Singer Family Fund for Lupus Research. A.R.'s work was funded by LUPUS UK, The Rosetrees Trust and Arthritis Research UK Programme Grant 19423 and supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. D.A.I. is supported by Arthritis Research UK Grant 20164. The Hopkins Lupus Cohort is supported by the National Institute of Health (NIH) (grant AR43727). P.F. presently holds a tier 1 Canada Research Chair on Systemic Autoimmune Rheumatic Diseases at Université Laval, and part of this work was done while he was still holding a Distinguished Senior Investigator of The Arthritis Society. I.N.B. is an NIHR Senior Investigator and is funded by Arthritis Research UK, the National Institute for Health Research Manchester Biomedical Research Unit and the NIHR/Wellcome Trust Manchester Clinical Research Facility. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. B.P. is supported by National Institute for Health Research Manchester Biomedical Research Unit and the NIHR/Welcome Trust Manchester Clinical Research Facility. S.J. is supported by the Danish Rheumatism Association (A1028) and the Novo Nordisk Foundation (A05990). R.R.-G.'s work was supported by the NIH (grants 8UL1TR000150 formerly UL-1RR-025741, K24-AR-02318 and P60AR064464 formerly P60-AR-48098). M.A.D.'s work was supported by the NIH grant RR00046. G.R.-I. is supported by the Department of Education, Universities and Research of the Basque Government.

Keywords

Epidemiology
Glucocorticoids
Systemic lupus erythematosus

ASJC Scopus subject areas

Rheumatology
Pharmacology (medical)

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10.1093/rheumatology/kex444

Cite this

Little, J., Parker, B., Lunt, M., Hanly, J. G., Urowitz, M. B., Clarke, A. E., Romero-Diaz, J., Gordon, C., Bae, S. C., Bernatsky, S., Wallace, D. J., Merrill, J. T., Buyon, J., Isenberg, D. A., Rahman, A., Ginzler, E. M., Petri, M., Dooley, M. A., Fortin, P., ... Bruce, I. N. (2018). Glucocorticoid use and factors associated with variability in this use in the Systemic Lupus International Collaborating Clinics Inception Cohort. Rheumatology (United Kingdom), 57(4), 677-687. https://doi.org/10.1093/rheumatology/kex444

@article{eb83d7b85f9247e191bfb40246f700e8,

title = "Glucocorticoid use and factors associated with variability in this use in the Systemic Lupus International Collaborating Clinics Inception Cohort",

abstract = "Objectives. To describe glucocorticoid (GC) use in the SLICC inception cohort and to explore factors associated with GC use. In particular we aimed to assess temporal trends in GC use and to what extent physician-related factors may influence use. Methods. Patients were recruited within 15 months of diagnosis of SLE from 33 centres between 1999 and 2011 and continue to be reviewed annually. Descriptive statistics were used to detail oral and parenteral GC use. Cross sectional and longitudinal analyses were performed to explore factors associated with GC use at enrolment and over time. Results. We studied 1700 patients with a mean (S.D.) follow-up duration of 7.26 (3.82) years. Over the entire study period, 1365 (81.3%) patients received oral GCs and 447 (26.3%) received parenteral GCs at some point. GC use was strongly associated with treatment centre, age, race/ethnicity, sex, disease duration and disease activity. There was no change in the proportion of patients on GCs or the average doses of GC used over time according to year of diagnosis. Conclusion. GCs remain a cornerstone in SLE management and there have been no significant changes in their use over the past 10-15 years. While patient and disease factors contribute to the variation in GC use, between-centre differences suggest that physician-related factors also contribute. Evidence-based treatment algorithms are needed to inform a more standardized approach to GC use in SLE.",

keywords = "Epidemiology, Glucocorticoids, Systemic lupus erythematosus",

author = "Jayne Little and Ben Parker and Mark Lunt and Hanly, {John G.} and Urowitz, {Murray B.} and Clarke, {Ann E.} and Juanita Romero-Diaz and Caroline Gordon and Bae, {Sang Cheol} and Sasha Bernatsky and Wallace, {Daniel J.} and Merrill, {Joan T.} and Jill Buyon and Isenberg, {David A.} and Anisur Rahman and Ginzler, {Ellen M.} and Michelle Petri and Dooley, {Mary Anne} and Paul Fortin and Gladman, {Dafna D.} and Kristjan Steinsson and Rosalind Ramsey-Goldman and Khamashta, {Munther A.} and Cynthia Aranow and Meggan Mackay and Alarc{\'o}n, {Graciela S.} and Susan Manzi and Ola Nived and Andreas J{\"o}nsen and Zoma, {Asad A.} and {van Vollenhoven}, {Ronald F.} and Manuel Ramos-Casals and Guillermo Ruiz-Irastorza and Lim, {Sung Sam} and Kalunian, {Kenneth C.} and Murat Inanc and Kamen, {Diane L.} and Peschken, {Christine A.} and Soren Jacobsen and Anca Askanase and Jorge Sanchez-Guerrero and Bruce, {Ian N.}",

year = "2018",

month = apr,

day = "1",

doi = "10.1093/rheumatology/kex444",

language = "English (US)",

volume = "57",

pages = "677--687",

journal = "Rheumatology (United Kingdom)",

issn = "1462-0324",

publisher = "Oxford University Press",

number = "4",

}

Little, J, Parker, B, Lunt, M, Hanly, JG, Urowitz, MB, Clarke, AE, Romero-Diaz, J, Gordon, C, Bae, SC, Bernatsky, S, Wallace, DJ, Merrill, JT, Buyon, J, Isenberg, DA, Rahman, A, Ginzler, EM, Petri, M, Dooley, MA, Fortin, P, Gladman, DD, Steinsson, K, Ramsey-Goldman, R, Khamashta, MA, Aranow, C, Mackay, M, Alarcón, GS, Manzi, S, Nived, O, Jönsen, A, Zoma, AA, van Vollenhoven, RF, Ramos-Casals, M, Ruiz-Irastorza, G, Lim, SS, Kalunian, KC, Inanc, M, Kamen, DL, Peschken, CA, Jacobsen, S, Askanase, A, Sanchez-Guerrero, J & Bruce, IN 2018, 'Glucocorticoid use and factors associated with variability in this use in the Systemic Lupus International Collaborating Clinics Inception Cohort', Rheumatology (United Kingdom), vol. 57, no. 4, pp. 677-687. https://doi.org/10.1093/rheumatology/kex444

TY - JOUR

T1 - Glucocorticoid use and factors associated with variability in this use in the Systemic Lupus International Collaborating Clinics Inception Cohort

AU - Little, Jayne

AU - Parker, Ben

AU - Lunt, Mark

AU - Hanly, John G.

AU - Urowitz, Murray B.

AU - Clarke, Ann E.

AU - Romero-Diaz, Juanita

AU - Gordon, Caroline

AU - Bae, Sang Cheol

AU - Bernatsky, Sasha

AU - Wallace, Daniel J.

AU - Merrill, Joan T.

AU - Buyon, Jill

AU - Isenberg, David A.

AU - Rahman, Anisur

AU - Ginzler, Ellen M.

AU - Petri, Michelle

AU - Dooley, Mary Anne

AU - Fortin, Paul

AU - Gladman, Dafna D.

AU - Steinsson, Kristjan

AU - Ramsey-Goldman, Rosalind

AU - Khamashta, Munther A.

AU - Aranow, Cynthia

AU - Mackay, Meggan

AU - Alarcón, Graciela S.

AU - Manzi, Susan

AU - Nived, Ola

AU - Jönsen, Andreas

AU - Zoma, Asad A.

AU - van Vollenhoven, Ronald F.

AU - Ramos-Casals, Manuel

AU - Ruiz-Irastorza, Guillermo

AU - Lim, Sung Sam

AU - Kalunian, Kenneth C.

AU - Inanc, Murat

AU - Kamen, Diane L.

AU - Peschken, Christine A.

AU - Jacobsen, Soren

AU - Askanase, Anca

AU - Sanchez-Guerrero, Jorge

AU - Bruce, Ian N.

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Objectives. To describe glucocorticoid (GC) use in the SLICC inception cohort and to explore factors associated with GC use. In particular we aimed to assess temporal trends in GC use and to what extent physician-related factors may influence use. Methods. Patients were recruited within 15 months of diagnosis of SLE from 33 centres between 1999 and 2011 and continue to be reviewed annually. Descriptive statistics were used to detail oral and parenteral GC use. Cross sectional and longitudinal analyses were performed to explore factors associated with GC use at enrolment and over time. Results. We studied 1700 patients with a mean (S.D.) follow-up duration of 7.26 (3.82) years. Over the entire study period, 1365 (81.3%) patients received oral GCs and 447 (26.3%) received parenteral GCs at some point. GC use was strongly associated with treatment centre, age, race/ethnicity, sex, disease duration and disease activity. There was no change in the proportion of patients on GCs or the average doses of GC used over time according to year of diagnosis. Conclusion. GCs remain a cornerstone in SLE management and there have been no significant changes in their use over the past 10-15 years. While patient and disease factors contribute to the variation in GC use, between-centre differences suggest that physician-related factors also contribute. Evidence-based treatment algorithms are needed to inform a more standardized approach to GC use in SLE.

AB - Objectives. To describe glucocorticoid (GC) use in the SLICC inception cohort and to explore factors associated with GC use. In particular we aimed to assess temporal trends in GC use and to what extent physician-related factors may influence use. Methods. Patients were recruited within 15 months of diagnosis of SLE from 33 centres between 1999 and 2011 and continue to be reviewed annually. Descriptive statistics were used to detail oral and parenteral GC use. Cross sectional and longitudinal analyses were performed to explore factors associated with GC use at enrolment and over time. Results. We studied 1700 patients with a mean (S.D.) follow-up duration of 7.26 (3.82) years. Over the entire study period, 1365 (81.3%) patients received oral GCs and 447 (26.3%) received parenteral GCs at some point. GC use was strongly associated with treatment centre, age, race/ethnicity, sex, disease duration and disease activity. There was no change in the proportion of patients on GCs or the average doses of GC used over time according to year of diagnosis. Conclusion. GCs remain a cornerstone in SLE management and there have been no significant changes in their use over the past 10-15 years. While patient and disease factors contribute to the variation in GC use, between-centre differences suggest that physician-related factors also contribute. Evidence-based treatment algorithms are needed to inform a more standardized approach to GC use in SLE.

KW - Epidemiology

KW - Glucocorticoids

KW - Systemic lupus erythematosus

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U2 - 10.1093/rheumatology/kex444

DO - 10.1093/rheumatology/kex444

M3 - Article

C2 - 29361147

AN - SCOPUS:85045074075

SN - 1462-0324

VL - 57

SP - 677

EP - 687

JO - Rheumatology (United Kingdom)

JF - Rheumatology (United Kingdom)

IS - 4

ER -

Glucocorticoid use and factors associated with variability in this use in the Systemic Lupus International Collaborating Clinics Inception Cohort

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