OBJECTIVES:

Systemic lupus erythematosus (SLE) treatments include steroids, antimalarials, immunosuppressants and/or biologics. We examine treatment choices in the last three years within community rheumatology practices to understand current use of biologics, persistence to belimumab, the most commonly used biologics for SLE, and association with different treatment and patient characteristics.

METHODS:

The ARN-TRIO Health Rheumatology registry contains EMR, medical claims, and prescription data generated in care of >100,000 patients by ARN, a network of independent practices. Inclusion criteria: Adult (18+) patients with SLE who initiated or switched to a new treatment from Jan 2017-May 2020. Statistical analysis used t-test (continuous variables) and chi-square/Fischer’s exact tests (categorical variables). Time to events analyses were conducted by Kaplan-Meier and subsequent log-rank test.

RESULTS:

Study population (n= 5,797): 10,913 distinct treatments at start. Start percentages by drug class, 2017-2019 indicated annualized growth rates of 20%, 7%, 2%, -2% for biologics, immunosuppressants, steroids, and antimalarials respectively, with significant differences (p<0.050) for all drug classes except steroids. Patients were classified into biologics/non-biologics group by initial treatment and compared. Biologic therapies were mostly belimumab (66%, 347/525); rituximab (11%, 60/525). Compared to the non-biologics, the biologics group differed in use of other drug classes and payer, but not in age, gender, or race. Mean time to belimumab discontinuation was 838 days (25^th percentile = 620 days, median not reached). Time to belimumab discontinuation differed by concomitant use of other drug classes and was not associated with age, gender, race, or payer.

CONCLUSIONS:

The use of biologics for SLE has increased considerably since 2017. For patients that received belimumab, persistence on therapy was substantial and increased in populations receiving concomitant steroids, antimalarials, or immunosuppressants.