1878: Customized Therapy for SLE: How Disease Severity Influences the Use of Corticosteroids and Biologics in Patients with SLE in the Lupus Federated Data Network (LupusNet) and a US Claims Database

Background/Purpose: The management of SLE varies worldwide. Current SLE treatment goals focus on preventing flares, controlling disease activity, and preventing organ damage accrual. LupusNet is the largest federated data network in SLE that combines and harmonizes data from 5 existing registries to enable greater data consistency and enhance understanding of global clinical presentations and outcomes of SLE. This study assessed treatment patterns for patients with SLE, categorized by disease severity, from LupusNet and a US claims database.

Methods: Data from 3 of 5 SLE registries in LupusNet, APLC (Asia Pacific), RELESSER (Europe), and Almenara (South America), were analyzed from 2012 to 2024, using a privacy-preserving federated data network approach where only aggregated results were shared. Additionally, data from the US Merative MarketScan^® Commercial Claims and Encounters (CCAE) Database from 2019 to 2024 were included in the analysis. In LupusNet, data from patients with ≥3 years of follow-up and ≥3 follow-up visits were collected and stratified into mild, moderate, or severe disease based on a SLEDAI score at year 3 follow-up visit (Table 1). In the US claims database, data from patients who were diagnosed with SLE were stratified by mild, moderate, or severe disease based on documented symptoms and clinical features (Table 1). Treatment exposures (ie, glucocorticoids, antimalarials, immunosuppressants, biologic therapies, and other immunosuppressants/immunomodulators) were assessed over follow-up.

Results: LupusNet included 3857 eligible patients: 3070 with mild disease, 637 with moderate disease, and 150 with severe disease. US claims data included 49,350 eligible patients: 23,461 with mild disease, 16,172 with moderate disease, and 9717 with severe disease. Glucocorticoid use was widespread across all disease severity levels: 63%-65% of patients with mild disease, 76%-84% with moderate disease, and 89%-95% with severe disease received glucocorticoids in both LupusNet and US claims data (Figure 1). Antimalarials were also frequently prescribed in 58%-66% of patients, regardless of disease severity. In contrast, use of immunosuppressants varied with disease severity: 25%-50% of patients with mild disease, 43%-67% with moderate disease, and 69%-81% with severe disease received immunosuppressants. Biologic therapies and other immunosuppressants/immunomodulators were utilized less frequently across all disease severity levels in LupusNet (4% and 2%-4%, respectively), while the use of these therapies increased with disease severity in US claims data (8%-44% and 4%-13%, respectively).

Conclusion: This analysis of patient data from LupusNet registries and the US claims database revealed that a considerable number of patients with active, severe SLE across geographic locations were not receiving immunosuppressants or biologic therapies. This suggests a heavy dependence on glucocorticoids to control disease activity and a potential underutilization of steroid-sparing therapies. Additional research is needed to explore long-term treatment trends and barriers to accessing treatments in patients with SLE.