Patterns of Glucocorticoid Use Among Persons with Systemic Lupus Erythematosus (SLE) over Fifteen Years

OBJECTIVES: In spite of the recent introductions of new medications for systemic lupus erythematosus (SLE) and guidelines to minimize glucocorticoid (GC) use, GCs remain a mainstay of SLE treatment. We examined patterns of GC use over fifteen years (2006-2021) in two longitudinal U.S. SLE cohorts.

METHODS: Data from the Lupus Outcomes Study (LOS, 2003-2015) and FORWARD Lupus Registry (FLR) (2015-2021) were used. LOS data were collected annually by interview; FLR data are collected every six months by questionnaire. In each study, participants reported both any use of GCs and GC dosages in the previous 12 months (LOS) or 6 months (FLR). Dosages were categorized as none, low/moderate (>0 to <10 mg/day) and high (≥10 mg/day). Frequency of GC use, overall and by dosage, was ascertained by data collection period over the 15-year time span.

RESULTS: At first study observation, 56% of the LOS cohort and 46% of the FORWARD cohort reported use of GCs at the time of data collection. Baseline GC dosage was similar in the two cohorts (LOS: 8.6 ± 9.1 mg/day, FLR: 9.1 ± 12.2 mg/day). A similar portion reported high dose GC use at first observation (LOS: 12.9%; FLR: 13.4%). The proportion of individuals using any GC and the proportion using high-dose GC were relatively consistent over time within each cohort.

CONCLUSIONS: Patterns of GC use and high-dose use were relatively stable over the 15-year period in two large longitudinal cohorts. Despite recommendations on steroid-sparing, a large portion of people with SLE appear to remain on steroids, with a significant portion remaining on high doses. There may be multiple reasons for this, including lack of other treatments to address some SLE manifestations or symptoms, lack of access to other medications, or patient preference. Regardless, these analyses underscore the need for other effective treatments for SLE.