Evidence for the utility of medications in settings lacking randomised trial data can come from studies of treatment persistence. We examined patterns of medication use in systemic lupus erythematosus (SLE) using data from a large multicentre longitudinal cohort.
Prospectively collected data from the Asia Pacific Lupus Collaboration cohort including disease activity (SLEDAI-2K) and medication details, captured at every visit from 2013-18, were used. Medications were categorised as glucocorticoids (GC), anti-malarials (AM), and immunosuppressants (IS). Cox regression analyses were performed to determine the time-to-discontinuation of medications, stratified by SLE disease activity.
Data from 19,804 visits of 2,860 patients were analysed. Eight medication categories were observed: no treatment; GC, AM or IS only; GC+AM; GC+IS; AM+IS and GC+AM+IS (triple therapy). Triple therapy was the most frequent pattern (31.4% of visits); single agents were used in 21% of visits and biologicals in only 3%. Time-to-discontinuation analysis indicated that medication persistence varied widely, with the highest treatment persistence for AM and lowest for IS. Patients with time-adjusted mean SLEDAI-2K≥10 had lower discontinuation of GC and higher discontinuation of IS.
Most patients received combination treatment. GC persistence was high, while IS persistence was low. Patients with high disease activity received more medication combinations but had reduced IS persistence, consistent with limited utility. These data confirm unmet need for improved SLE treatments.