Glucocorticoids prescribing practices in systemic sclerosis: an analysis of the EUSTAR database

Area of Science:

• Rheumatology
• Clinical Pharmacology
• Epidemiology

Background:

• Systemic Sclerosis (SSc) is a complex autoimmune disease where long-term medication use is common.
• Glucocorticoids (GCs) are frequently prescribed for SSc, but their long-term use and associated prescribing patterns require detailed investigation.

Purpose of the Study:

• To estimate the prevalence of long-term glucocorticoid (GC) exposure in patients with Systemic Sclerosis (SSc).
• To identify factors associated with GC use and analyze variations in prescribing practices over time and across different countries.
• To explore time trends and geographical differences in GC utilization within the SSc population.

Main Methods:

• Analysis of data from 9819 SSc patients in the EUSTAR database (from January 2013 onwards).
• Examination of GC prevalence, user characteristics, exposure duration, and dosages.
• Multivariable linear regression to identify factors associated with GC intake duration; exploration of time trends and country variations; multiple imputation for missing data.

Main Results:

• At baseline, 34% of SSc patients were on GCs, with users more likely to have diffuse cutaneous SSc (dcSSc) and more severe disease.
• GC users spent a median of 33.2 months on medication, with 22% receiving GCs for over 12 months.
• Prescribing varied significantly across countries and gradually decreased from 36% in 2013 to 23% in 2018; patient/disease characteristics explained only 6% of variability in GC exposure.

Conclusions:

• Glucocorticoids are widely and chronically prescribed in Systemic Sclerosis, exhibiting considerable international and national prescribing variations.
• A notable decrease in GC utilization has been observed over the study period.
• Further research is needed to understand the drivers of prescribing variability and optimize GC use in SSc management.