POS0537 GLOBAL PERSPECTIVES ON GLUCOCORTICOID MANAGEMENT IN SYSTEMIC LUPUS ERYTHEMATOSUS: RESULTS FROM THE LUPHPOS SURVEY

Background:

Glucocorticoids (GCs) play a pivotal role in the treatment of active SLE, however their use is associated with the risk of organ damage which is irreversible. The lack of specific guidelines due to insufficient evidence, and the inherent heterogeneity of the disease, pose challenges for GC initiation and withdrawal.

Objectives:

To explore the variations in prescribing practices and attitudes toward initiating/withdrawing GC therapy in SLE, amongst physicians practicing in European and non-European countries.

Methods:

The LUPHPOS (LUpus PHysician' Perspective On glucocorticoidS) study is an online cross-sectional self-reported survey on the physician's perspective of glucocorticoids in the management of SLE, disseminated between April-December 2023. We have compared responses between practitioners practicing within Europe, and those practicing outside of Europe.

Results:

The survey was completed by 501 physicians, 269 (54%) from Europe and 232 (46%) from non-European countries, with the distribution of countries shown in Figure 1. The top three countries to respond were India (n=127, 25%), Italy (n=72, 14%), Spain (n=60, 12%). The majority of respondents (82%) were adult rheumatologists, and 70% reported working in a university hospital. Around half (45%) of respondents had a dedicated lupus clinic, which was more common in Europe (51% vs 39%, p=0.007). Comparing European with non-European physicians, the top three influencing factors for selecting GC dose were current disease activity (80% and 85%) and organ involvement (77% and 86%), followed by comorbidities (40%) in Europeans, and the course of the disease (34%) for non-European physicians. The most concerning GC adverse effect reported by European physicians was infection (38%), osteoporosis (21%) and cushingoid features (12%); for non-European physicians it was infection (34%), cushingoid features (20%) and avascular necrosis (16%). When initiating GCs, a weight-based regimen was used less frequently by European physicians (48% vs 70%, p<0.001). In severe flares, pulse GC was preferred in both groups (75% vs 78%). The commonest dose was 500 mg/day for European physicians (45%), and 1000 mg/day for non-European physicians (37%). In a moderate flare, in those who preferred weight-based dosing, most commonly used doses were 0.25-0.3 mg/kg/day (21% vs 25%) and 0.5mg/kg/day (15% vs 25%). In those preferring fixed-dosing, the most common dose was 15-20 mg/day (18% vs 8%). For mild flares, the majority of European and non-European respondents reported using oral GCs (77% vs 74%). The commonest doses were 0.25 mg/kg/day (46% vs 33%) or 5-10 mg/day (37% vs 41%), in Europeans compared with non-Europeans. Comparing European and non-European physicians, GC withdrawal was most commonly reported when patients had been in remission or LLDAS at least 12 months (41% vs 28%), or on achieving remission (32% vs 27%). European physicians were less likely to believe that GCs could rarely, or never be withdrawn (5% vs 11%). 51% of European and 48% of non-European physicians agreed that the most acceptable target dose for tapering steroids was ≤5 mg/day, however Europeans were less likely to find ≤10 mg/day acceptable (3% vs 7%). Both groups agreed that disease activity, organ involvement and time since latest flare were the most influential factors for withdrawing GCs.

Conclusion:

Physician location influences GC prescribing practices and safety considerations, impacting dosing selection, withdrawal, and tapering strategies. These geographical disparities underscore the need for a consensus on evidence-based care, and global implementation and dissemination strategies.

REFERENCES:

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Acknowledgements:

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Disclosure of Interests:

Sarah Dyball Novartis, UCB, Cristiana Sieiro Santos: None declared, Kunal Ashutosh Chandwar: None declared, Elisabetta Chessa: None declared, Marta Mosca Abbvie, Astra Zeneca, Gsk, Lilly, UCB, Janssen, Otsuka.