Glucocorticoids prescribing practices in systemic sclerosis: an analysis of the EUSTAR database
Michele Iudici, Denis Mongin, Elise Siegert, Patrícia Carreira, Jörg H. W. Distler, Jörg Henes, Elisabetta Zanatta, É. Hachulla, Giacomo De Luca, Carolina de Souza Müller, Tânia Santiago, Jose‐Luis Tandaipan, Breno Valdetaro Bianchi, Maria De Santis, Anna‐Maria Hoffmann‐Vold, Armando Gabrielli, Oliver Distler, Delphine S. Courvoisier, EUSTAR collaborators, Giovanna Cuomo, Gianluca Moroncini, Jiří Štork, Fiorenzo Iannone, Ulrich A. Walker, Eugenia Bertoldo, Dorota Krasowska, Maria João Salvador, Mohammed Tikly, Valeria Riccieri, Ami Sha, Ana Maria Gheorghiu, Cord Sunderkötter, Francesca Ingegnoli, Luc Mouthon, Vanessa Smith, Francesco Paolo Cantatore, Kilian Eyerich, Piotr Wiland, Marie Vanthuyne, Branimir Anić, Maria Üprus, B. Granel, Alessandra Vacca, Cristina-Mihaela Tănăseanu, Paloma García de la Peña Lefebvre, Jean Sibilia, Ira Litinsky, Lesley Ann Saketkoo, Eduardo Kerzberg, Massimiliano Limonta, Doron Rimar, Petros P. Sfikakis, Maurizio Cutolo, Rosario Foti, Srđan Novak, Mislav Radić, Raffaele Pellerito, Carlo Francesco Selmi Rozzano, Lidia P Ananieva, G Szücs, Carlos de la Puente, Ruxandra Ionescu, Maria Rosa Pozzi, Juan José Alegre Sancho, Kristine Herrmann, Ellen De Langhe, Sule Yavuz Altunizade, Svetlana Agachi, Douglas J. Veale, Esthela Loyo, Mengtao Li, Edoardo Rosato, Britta Maurer, I. Castellví, François Spertini, Kamal Solanki, Nicoletta Del Papa, Gerard Espinosa, László Czirják, Bernard Coleiro, Dominique Farge Bancel, Raffaele Pellerito, Christopher P. Denton, Nemanja Damjanov, Vera Ortiz Santamaria Granollers, Michaela Köhm, Bojana Stamenković, Yannick Allanore, Paolo Airó, Alexandra Balbir‐Gurman, Marco Matucci‐Cerinic, Gabriela Riemekasten, Stefan Heitmann, Nicolas Hunzelmann, Carlomaurizio Montecucco, Jadranka Morović‐Vergles, Camillo Ribi
Abstract
OBJECTIVES: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.