Patients Taking Oral Corticosteroids for Systemic Lupus Erythematosus Face High Costs

Individuals with systemic lupus erythematosus (SLE) face a substantial economic burden in the first 12 months following initiation of treatment with oral corticosteroids (OCS), according to a study published in ACR Open Rheumatology. The authors noted their findings may point to the need to minimize the use of OCS in this patient population.

Corticosteroids are commonly prescribed for the treatment of SLE due to their anti-inflammatory and immunosuppression effects, but prolonged use is associated with increased risk of adverse events (AEs) and organ damage. In addition, the economic burden linked to continued use of these medications may significantly impact patients. To investigate the clinical and economic burden associated with OCS use in individuals with SLE, researchers conducted a retrospective cohort study using data from the IQVIA Real-World Data Adjudicated Claims–US database. Patients were at least 5 years of age at the time of corticosteroid initiation and were monitored over a 12-month period.

A total of 16,216 patients who had 1 or more OCS pharmacy claims during the study period, with no evidence of baseline use, were included in an “initiator” cohort. A total of 11,137 patients with no OCS claims during the study period comprised a “no-use” cohort. Most patients were female, and the no-use cohort was older than the initiator cohort (average age, 47.3 years vs 44.9 years). The no-use cohort had a reduced comorbidity burden and lower concomitant medication use than the cohort that initiated corticosteroids. The no-use cohort also contained fewer patients with moderate-to-severe SLE.

During the observation period, patients who initiated OCS had a higher disease burden and more frequent and severe SLE flares than those who did not use corticosteroids. Also, patients in the initiator cohort demonstrated higher health care resource utilization and incurred costs than the no-use group, “largely driven by outpatient visits and inpatient stays,” the authors noted. In the months prior to medication initiation, those patients had greater concomitant medication use and health care costs than the no-use cohort, “suggesting they represent a group of patients with potentially more severe disease requiring additional care,” according to the authors.

The higher resource use and costs may be partially explained by AEs associated with the use of OCS, such as cardiovascular events or organ involvement, the authors wrote. Costs associated with corticosteroid-related AEs were estimated to be between $2400 and $9800 per year. In addition, patients receiving higher doses of OCS reported more frequent urgent care visits than patients receiving lower doses. The authors noted that 12.5% of patients taking OCS were prescribed a dose greater than the recommended 7.5 mg/day to prevent irreversible organ damage for at least 6 of the 12 months of observation.

In their conclusion, the authors wrote that their findings “may imply a need to minimize OCS use.” They noted that the greatest cost and AE burden “was seen in patients receiving average doses of more than 5 mg/day.” They emphasized the importance of adherence to current dose and duration guidelines for use of OCS in order to “reduce the clinical and economic burden of SLE management.”