Temporal trends in glucocorticoids and hydroxychloroquine for treatment of systemic lupus erythematosus in Sweden

Abstract

Objectives 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. Methods 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. Results 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%). Conclusion 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.