Dominicus Annica, Mageau Arthur, Nguyen Ngoc V, Blomkvist Sporre Karin, Svenungsson Elisabet, Arkema Elizabeth V
Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Internal Medicine Department, Hôpital Bichat-Claude Bernard, AP-HP, Université Paris Cité, Paris, France.
Rheumatology (Oxford). 2025 Aug 1;64(8):4622-4630. doi: 10.1093/rheumatology/keaf192.
It is unknown to what extent updated treatment recommendations regarding glucocorticoids (GC) and hydroxychloroquine (HCQ) for patients with systemic lupus erythematosus (SLE) have been incorporated into clinical practice. Based on filled dispensations we examined treatment patterns the first 5 years after SLE diagnosis in Sweden, trends over time and relationship to patient characteristics.
A cohort of patients with newly diagnosed SLE between 2005 and 2021 with information on drug dispensations, hospitalizations, specialized outpatient visits and patient characteristics were identified through a linkage of Swedish population registers (n = 3891, 83% females, mean age 48.8). Treatment patterns, including accumulated exposure to GC and HCQ and combinations of treatments, were investigated in relation to year of diagnosis and patient characteristics using visualizations, logistic regression and quantile regression analysis.
The proportion of SLE patients treated with GC during the first year after diagnosis was 68.3% over the study period. For the fifth year it decreased from 54.1% to 46.3%. The median decrease in 5-year cumulative GC dose attributable to calendar year was 753 mg (90% CI: 1560 mg decrease, 106 mg increase) with a more pronounced trend towards fewer patients on the highest exposure levels. The median increase in proportion of days covered with HCQ during 5 years was 28.6% (90% CI: 21.9%, 36.2%).
The modest reduction of GC exposure and substantial increase in HCQ coverage over time aligns with changes in recommendations for SLE management. However, treatment optimization and continued efforts to raise awareness remain essential to ensure equal care and improve clinical outcomes.
关于系统性红斑狼疮（SLE）患者使用糖皮质激素（GC）和羟氯喹（HCQ）的最新治疗建议在多大程度上已被纳入临床实践尚不清楚。基于已配发的药物，我们研究了瑞典SLE诊断后前5年的治疗模式、随时间的趋势以及与患者特征的关系。
通过瑞典人口登记册的链接，确定了2005年至2021年间新诊断为SLE的患者队列，这些患者有药物配发、住院、专科门诊就诊和患者特征等信息（n = 3891，83%为女性，平均年龄48.8岁）。使用可视化、逻辑回归和分位数回归分析，研究了治疗模式，包括GC和HCQ的累积暴露量以及联合治疗，与诊断年份和患者特征的关系。
在研究期间，SLE患者在诊断后第一年接受GC治疗的比例为68.3%。到第五年，这一比例从54.1%降至46.3%。由于日历年导致的5年累积GC剂量中位数下降为753毫克（90%置信区间：减少1560毫克，增加106毫克），在最高暴露水平下接受治疗的患者数量减少的趋势更为明显。5年中HCQ覆盖天数比例的中位数增加了28.6%（90%置信区间：21.9%，36.2%）。
随着时间的推移，GC暴露量适度减少，HCQ覆盖范围大幅增加，这与SLE管理建议的变化一致。然而，治疗优化以及持续努力提高认识对于确保平等治疗和改善临床结果仍然至关重要。
