Article ; Online: Utilization of glucocorticoids among White and Black patients with systemic lupus erythematosus: Observations from the enrollment visit of a prospective registry.
2021 Volume 30, Issue 14, Page(s) 2298–2303
Abstract: Background: Black patients with systemic lupus erythematosus (SLE) face higher rates of morbidity and mortality compared to White patients. Long-term glucocorticoid use has been associated with worse health outcomes among patients with SLE. We sought to ...
| Abstract | Background: Black patients with systemic lupus erythematosus (SLE) face higher rates of morbidity and mortality compared to White patients. Long-term glucocorticoid use has been associated with worse health outcomes among patients with SLE. We sought to quantify chronic glucocorticoid use among Black and White patients with SLE within a prospective registry. Methods: Using enrollment data from a registry at a large academic institution, we compared glucocorticoid use among Black and White patients with SLE. Multivariable logistic regression of race and glucocorticoid use was performed, adjusting for covariates exhibiting a bivariate association with glucocorticoids at significance level Results: 114 White participants (mean age 45; standard deviation (SD) 15) and 59 Black participants (mean age 42; SD 14) were analyzed. White participants had mean SLEDAI-2K score of 3.7 (SD 5.2). Black participants had mean SLEDAI-2K scores of 6.3 (SD 6.0). Among Black participants, 43 (72%) utilized glucocorticoids compared to White participants 39 (34%) (unadjusted odds ratio (OR) 5.17; 95% confidence interval (CI) 2.59-10.33). We did not observe differences between unadjusted hydroxychloroquine (OR 0.69; 95% CI 0.28-1.65) or conventional disease-modifying anti-rheumatic drug (cDMARD) (OR 1.07; 95% CI 0.57-2.01) utilization among Black and White participants. SLEDAI-2K, disability, recent hospitalization, and past or present hydroxychloroquine or cDMARD use were included in a logistic regression model. Adjusting for covariates, Black participants were more likely to be on glucocorticoids (adjusted OR 5.69; 95% CI 2.17-14.96); Conclusion: Adjusting for disease activity and other medications, Black patients had more exposure to chronic glucocorticoids than White patients in the Cleveland Clinic SLE registry. These patients may face increased glucocorticoid-related morbidity, which could contribute significantly to long-term health outcomes and utilization of health care resources. Future research in larger, more diverse registries should be conducted to further characterize patterns of glucocorticoid use. |
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| MeSH term(s) | Adult ; Antirheumatic Agents/therapeutic use ; Glucocorticoids/therapeutic use ; Humans ; Hydroxychloroquine/therapeutic use ; Lupus Erythematosus, Systemic/drug therapy ; Middle Aged ; Registries ; Severity of Illness Index |
| Chemical Substances | Antirheumatic Agents ; Glucocorticoids ; Hydroxychloroquine (4QWG6N8QKH) |
| Language | English |
| Publishing date | 2021-11-21 |
| Publishing country | England |
| Document type | Journal Article |
| ZDB-ID | 1154407-7 |
| ISSN | 1477-0962 ; 0961-2033 |
| ISSN (online) | 1477-0962 |
| ISSN | 0961-2033 |
| DOI | 10.1177/09612033211055817 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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