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Patterns of drug therapy in newly diagnosed Spanish patients with systemic lupus erythematosus
G. Ruiz-Irastorza1, M. García2, G. Espinosa3, I. Cabezas-Rodríguez4, F. Mitjavila5, R. González-León6, B. Sopeña7, I. Perales8, B. Pinilla9, M. Rodríguez-Carballeira10, J.M. López-Dupla11, J.L. Callejas12, A. Castro13, C. Tolosa14, M.E. Sánchez-García15, M. Pérez-Conesa16, N. Navarrete-Navarrete17, A.P. Rodríguez18, M.T. Herranz19, L. Pallarés20
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Bizkaia, Spain. r.irastorza@outlook.es
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Bizkaia, Spain.
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain.
- Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain.
- Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
- Department of Internal Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
- Department of Internal Medicine, Complejo Hospitalario Universitario de Vigo, Spain.
- Department of Internal Medicine, Hospital Universitario Fuenlabrada, Madrid, Spain.
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
- Department of Internal Medicine, Hospital Universitario Mutua de Terrasa, Barcelona, Spain.
- Department of Internal Medicine, Hospital Universitario Joan XXIII, Tarragona, Spain.
- Department of Internal Medicine, Hospital Universitario San Cecilio, Granada, Spain.
- Department of Internal Medicine, Hospital Universitario Sant Joan de Reus, Tarragona, Spain.
- Department of Internal Medicine, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain.
- Department of Internal Medicine, Autoimmune Diseases Unit, Hospital Universitario Reina Sofía, Córdoba, Spain.
- Department of Internal Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain.
- Department of Internal Medicine, Hospital Universitario Virgen de las Nieves, Granada, Spain.
- Department of Internal Medicine, Complejo Hospitalario Universitario de Ourense, Spain.
- Department of Internal Medicine, Hospital J.M. Morales Meseguer, Murcia, Spain.
- Department of Internal Medicine, Hospital Universitario Son Espases, Palma de Mallorca, Spain.
on behalf of RELES, Autoimmune Diseases Study Group GEAS
CER8993
2016 Vol.34, N°3
PI 0466, PF 0472
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PMID: 26940538 [PubMed]
Received: 21/09/2015
Accepted : 07/12/2015
In Press: 26/02/2016
Published: 30/05/2016
Abstract
OBJECTIVES:
This is the first Spanish multicentric inception lupus cohort, formed by SLE patients attending Spanish Internal Medicine Services since January 2009. We aimed to analyse drug therapy during the first year of follow-up according to disease severity.
METHODS:
223 patients who had at least one year of follow-up were enrolled upon diagnosis of SLE. Therapy with prednisone, pulse methyl-prednisolone, hydroxychloroquine, immunosuppressives and calcium/vitamin D was analysed.
RESULTS:
Prednisone was given to 65% patients, at a mean (SD) daily dose of 11 (10) mg/d. 38% patients received average doses >7.5 mg/d during the first year. Patients with nephritis and with a SLEDAI ≥6 were treated with higher doses of prednisone. 81% of patients were treated with hydroxychloroquine, with higher frequency among those with a SLEDAI ≥6 (88% vs. 68%, p<0.001). The use of immunosuppressive drugs and methyl-prednisolone pulses was higher in patients with a baseline SLEDAI ≥6, however, differences were no longer significant when patients with lupus nephritis were excluded. The use of calcium/vitamin D increased with the dose of prednisone, however, 43% of patients on medium-high doses of prednisone did not take any calcium or vitamin D.
CONCLUSIONS:
This study gives a real-world view of the current therapeutic approach to early lupus in Spain. The generalised use of hydroxychloroquine is well consolidated. There is still a tendency to use prednisone at medium to high doses. Pulse methyl-prednisolone and immunosuppressive drugs were used in more severe cases, but not as steroid sparing agents. Vitamin D use was suboptimal.
