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    Survey uncovers lupus corticosteroid treatment issues


    Patients with systemic lupus erythematosus (SLE) often self-manage their corticosteroid medication without the consent of their healthcare providers, according to a recent multicountry survey.


    The EnAble survey of rheumatologists and internal medicine providers in 7 countries—United States, Japan, Brazil, Spain, France, Germany and Italy)—was needed in part because corticosteroid use is a significant contributor to long-term organ damage in SLE patients, Tania C. González-Rivera, MD, a rheumatologist and US Immuno-Inflammation Medical Director for GSK, told FormularyWatch.

    GlaxoSmithKline, the manufacturer of belimumab (Benlysta) to treat SLE, sponsored the study that was conducted by Cello Health Insight.

    With varied treatment approaches and no universally accepted guidelines in SLE, the survey was designed to provide an insight into discrepancies in current approaches to management between healthcare providers and patients and identify barriers to improved patient care.

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    Fewer than 40% of rheumatologists surveyed were aware that SLE leads to organ damage in 30% to 50% of patients within five years of diagnosis. In addition, most healthcare providers accepted corticosteroid doses far exceeding the recommended clinical threshold, according to the survey.

    “Similarly, more than half (53%) of patients surveyed said they rely heavily on corticosteroids to get through difficult periods of lupus and 69% did not believe that their healthcare provider went beyond treating symptoms to fully manage all aspects of their persistently active SLE,” according to a statement from GlaxoSmithKline.

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    However, 37% of healthcare providers did not agree that long-term treatment/management was as important as immediate symptoms when caring for persistently active SLE patients.

    The cost of healthcare resource utilization for a severe flare is roughly $12,000 and the hospitalization rate for SLE patients with severe infections is more than 12 times higher than that of the general public, Gonzalez-Rivera said.

    “For many people, lupus can be managed successfully with early diagnosis and expert medical care; but a balance needs to be struck—between treating symptoms as they evolve and proactively reducing underlying disease activity and preventing flares—if the risk of long-term organ damage is to be reduced,” said Alex Liakos, MD, with GSK’s Global Medical Affairs, in the statement.

    "EnABLE reveals a need for improved awareness around treating long-term impact of SLE and appropriate use of corticosteroids in SLE management,” Gonzalez-Rivera said.

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