Despite the high direct medical costs of treating systemic lupus erythematosus (SLE), opportunities exist for improving SLE treatment rates, treatment appropriateness, and referral to specialists, according to research presented at the Academy of Managed Care Pharmacy annual meeting.
“These changes may result in better clinical and economic outcomes for patients with SLE,” Hong Kan, PhD, of GlaxoSmithKline, suggested on the study poster.
Treatment options for SLE include corticosteroids, immunosuppressants, and biologics, each of which has a unique risk-benefit profile that should be considered by prescribing physicians. This retrospective observational study sought to identify treatment patterns in newly diagnosed SLE patients and their associated clinical and economic outcomes.
The investigators followed the treatment of an incident SLE cohort (N=1611) for 4 years, using the Truven MarketScan commercial claims database. The analysis included 5 SLE therapies: corticosteroids, hydroxychloroquine, azathioprine, mycophenolate mofetil, and methotrexate.
Clinical outcomes included number and severity of flares, as well as number of hospitalizations, emergency department visits, and office and outpatient visits. Economic outcomes included the total costs of hospitalizations, emergency department visits, office and outpatient visits, prescription drugs, and medical care.
“Treatment by specialists was associated with better clinical and economic outcomes, compared with treatment by primary care providers… [and] corticosteroid monotherapy was associated with the worst clinical and economic outcomes of all the treatment clusters,” Kan and colleagues indicated on their poster.
The study’s key findings were these:
- SLE treatments did not change substantially over the 4-year period in this newly diagnosed cohort
- Minimal treatment was the most common approach to managing these patients (42.8%)
- The greatest persistent and nonpersistent uses of the drugs were for hydroxychloroquine monotherapy (34.0%), corticosteroid monotherapy (11.2%), and the combination of these (7.8%)
- Clinical and economic outcomes were poorest with corticosteroid monotherapy
- Corticosteroid monotherapy outcomes may improve with the addition of hydroxychloroquine and/or immunosuppressive agents
- Compared with the minimally treated cluster, hydroxychloroquine monotherapy had similar or better outcomes
- A large proportion of SLE care is provided by non-specialists (45%), despite the potential benefits of involving specialists
Reference
Kan H, Nagar S, Patel J, et al. Longitudinal treatment patterns and associated outcomes in patients newly diagnosed with systemic lupus erythematosus (SLE) in the US. Poster presented at: Academy of Managed Care Pharmacy 27th Annual Meeting & Expo; April 7-10, 2015; San Diego, CA.