Lupus Medication Trends: Immunosuppressives and Prednisone Linked With Disease Activity and Damage

Treatment for systemic lupus erythematosus (SLE) with both immunosuppressive agents and prednisone is given to patients who have the most active disease, but the presence of cumulative damage also may predict use of these agents, particularly early in the disease course. Antimalarial agents are not so clearly related to disease activity or damage, suggesting that they are used regardless of clinical severity or less likely to be tapered when disease becomes less active.

Bernatsky and colleagues combined data from 10 clinical adult SLE cohort registries in Canada. They used multivariate generalized estimating equation methods to model dichotomized outcomes, running separate regressions where the outcome was patient exposure to specific medications. Response variables were classified as current immunosuppressive, antimalarial, or prednisone use.

Higher disease activity and damage scores were each independent predictors of exposure to nonsteroidal immunosuppressive agents and to prednisone but not to antimalarial agents. African American race was an additional independent risk factor for prednisone exposure. Older age at diagnosis was independently and inversely linked with exposure to any of the study medications.

The authors noted that these phenomena may appear to be intuitive, but they have not been previously studied or demonstrated in clinical practice