Cluster analysis of longitudinal treatment patterns in patients newly diagnosed with systemic lupus erythematosus in the United States
© Kan et al.; licensee BioMed Central Ltd. 2014
Published: 18 September 2014
Treatments for systemic lupus erythematosus (SLE) include corticosteroids (CS), antimalarials, nonsteroidal anti-inflammatory drugs, cytotoxic agents, and immunosuppressive/immunomodulatory agents. We examined treatment patterns in newly diagnosed SLE patients from a multipayer US claims database.
This study (GSK HO-13-13054) retrospectively followed incident SLE patients' treatment for 4 years in the MarketScan commercial claims database. The earliest medical claim date with SLE diagnosis (ICD-9 code 710.0x; 1 January 2002 to 31 March 2008) was the index date. Patients were ≥18 years at index, had continuous medical and pharmacy benefits for 12 months pre index without SLE diagnosis and 48 months post index, with ≥1 SLE-related inpatient claim or ≥2 office or emergency room visits with SLE diagnosis ≥30 days apart within 12 months post index. A specialist must have made ≥1 SLE diagnosis at index or within 12 months post index. Results were stratified by provider type (primary care physician (PCP)/specialist). A disjoint k-means cluster analysis identified treatment pathways using annual prescription numbers for CS, hydroxychloroquine (HCQ), mycophenolate mofetil, azathioprine, and methotrexate as input variables.
Longitudinal treatment patterns according to primary treatment by specialist or PCP
Treated primarily by specialistsa
Treated primarily by PCPsa
Not actively treated throughout (<0.05 (mean) annual prescriptions)
CS only: high number of prescriptions (chronic use)
CS only: moderate number of prescriptions with slow reduction
HCQ only: high number of prescriptions (chronic use)
HCQ only: moderate number of prescriptions (chronic use)
HCQ only: poor adherence
CS plus HCQ: high number of prescriptions (chronic use)
CS plus HCQ: poor adherence
Methotrexate: moderate number of prescriptions plus some prescriptions for CS and HCQ
Azathioprine: moderate number of prescriptions plus some prescriptions for CS and HCQ
Treatment patterns were observed among SLE patients using medical resources. In the 4 years post diagnosis: ~50% of patients were not actively treated; 50% received CS, HCQ, and immunosuppressants with differing combinations, intensities, and adherence levels. Specialists provided more intensive treatment than PCPs.
Study and editorial support (Natasha Thomas, Fishawack Indicia Ltd) funded by GlaxoSmithKline.
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