Iudici Michele, Mongin Denis, Siegert Elise, Carreira Patricia E, Distler Jörg, Henes Jörg, Zanatta Elisabetta, Hachulla Eric, De Luca Giacomo, de Souza Müller Carolina, Santiago Tânia, Tandaipan José-Luis, Valdetaro Bianchi Breno, De Santis Maria, Hoffmann-Vold Anna-Maria, Gabrielli Armando, Distler Oliver, Courvoisier Delphine Sophie
Division of Rheumatology, Department of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
Department of Rheumatology, Charité University Hospital, Berlin, Germany.
Rheumatology (Oxford). 2023 Apr 3;62(4):1559-1567. doi: 10.1093/rheumatology/keac533.
To estimate the prevalence of long-term exposure to glucocorticoids (GCs) and to identify factors associated with, and variations in prescribing practices over time and across recruiting countries.
We included patients with SSc having a visit recorded in the EUSTAR database from January 2013 onward. We analysed the prevalence and the main features of GCs users, their exposure to GCs over time, and their GCs dosages. Multivariable linear regression was used to analyse the factors identified as associated with GCs intake duration. Time trends, and variations in GCs utilization across recruiting countries were explored. Missing data were imputed using multiple imputation with chained equations.
The 9819 patients included were mostly females (85%), the majority had lcSSc (73%), and the median age was 58 years. At baseline, 34% of patients (n = 2769/8109) (48% dcSSc vs 29% lcSSc) were on GCs, and the median dose was 7.5 mg/day. GCs users were more frequently males and anti-Scl70 positive, and more commonly had dcSSc and more severe disease. On average, GCs users spent 25% of their follow-up time (median 33.2 months) on GCs, with no significant between-subsets difference. Notably, 33% (n = 971/2959) and 22% (n = 647/2959) of patients followed up for >1 year had received GCs for >6 and >12 months, respectively. Multivariable analysis showed that patient and disease characteristics poorly explained the variability in GCs exposure (adjusted-R2 = 0.06, P < 0.001). GCs utilization varied within and across countries, and gradually decreased over time (36% in 2013 vs 23% in 2018).
GCs are widely and long-term prescribed in SSc, with significant between-countries and within-country differences. A gradual decrease in their utilization has been observed.
评估长期暴露于糖皮质激素（GCs）的患病率，并确定与之相关的因素，以及随着时间推移和不同招募国家在处方实践方面的差异。
我们纳入了自2013年1月起在EUSTAR数据库中有就诊记录的系统性硬化症（SSc）患者。我们分析了GCs使用者的患病率和主要特征、他们随时间的GCs暴露情况以及GCs剂量。采用多变量线性回归分析确定为与GCs摄入持续时间相关的因素。探讨了时间趋势以及不同招募国家在GCs使用方面的差异。使用链式方程多重填补法对缺失数据进行填补。
纳入的9819例患者大多为女性（85%），多数为局限性皮肤型系统性硬化症（lcSSc）（73%），中位年龄为58岁。基线时，34%的患者（n = 2769/8109）（弥漫性皮肤型系统性硬化症[dcSSc]患者中占48%，lcSSc患者中占29%）正在使用GCs，中位剂量为7.5毫克/天。GCs使用者男性更多、抗Scl70抗体阳性率更高，更常患有dcSSc且疾病更严重。平均而言，GCs使用者随访时间的25%（中位时间33.2个月）在使用GCs，各亚组间无显著差异。值得注意的是，随访时间>1年的患者中，分别有33%（n = 971/2959）和22%（n = 647/2959）接受GCs治疗>6个月和>12个月。多变量分析显示，患者和疾病特征对GCs暴露变异性的解释能力较差（调整后R² = 0.06，P < 0.001）。GCs的使用在不同国家内部和之间存在差异，且随时间逐渐减少（2013年为36%，2018年为23%）。
在系统性硬化症中，GCs被广泛且长期处方，国家间和国家内部存在显著差异。已观察到其使用逐渐减少。
