OBJECTIVES: The daily dose of oral glucocorticoids (OCS) is associated with damage in Systemic Lupus Erythematosus (SLE), and OCS reduction is a major goal of SLE care. The aim of this study was to analyze OCS use in French patients with SLE.

METHODS: This study used the French health-insurance claims database (SNDS). SLE patients were identified with the ICD-10 code for SLE (M32).

Comorbidities related to SLE and to complications of OCS were identified through validated algorithms.

Treatments were identified through drug deliveries in pharmacies and daily OCS doses were calculated for the year 2019.

Comparisons were made to age and gender-matched controls without SLE from the general population.

RESULTS: A total of 31,852 patients with SLE (mean age 49.7 ± 15.9 years; 86.3% women) were alive on 1/1/2020, with a mean disease duration of 7.1 years.

Among these prevalent SLE patients, 48.2% were treated with OCS. OCS use was significantly more frequent in women, in patients with CMUc (specific health coverage for low-income patients) and decreased with age.

SLE-specific comorbidities and complications of OCS were significantly increased in patients with higher doses of OCS.

Use of SLE other treatments was significantly increased in patients with higher doses of OCS.

Strikingly, 14.2% of patients receiving 5 to 7.5 mg of OCS per day and 13.2% of those receiving more than 7.5 mg per day were not treated with antimalarial drugs, immunosuppressives or other biologic treatments for SLE.

The overall annual mean cost of healthcare consumptions from a societal perspective in 2019 was 5,894€ for prevalent SLE patients and 2,601€ for matched controls (p<0.0001). Among prevalent SLE patients, the cost increased significantly according to the OCS daily dose.

CONCLUSIONS: The proportion of patients treated with high-dose OCS ≥ 7.5mg/day remains unacceptably high and associated with increased comorbidities, OCS complications and significantly increased healthcare costs.