AB0342 ASSOCIATION OF GLUCOCORTICOID USE WITH HEALTHCARE UTILIZATION AMONG PERSONS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Abstract

BackgroundGlucocorticoids (GCs) have long been a mainstay of treatment for systemic lupus erythematosus (SLE). While GCs do provide benefit, there are potential side effects which increase with dose and duration. GC-associated adverse events have been linked to significant increased health care costs, although excess healthcare utilization due to GC events has not been examined in SLE.ObjectivesTo examine the association of GC use and healthcare utilization.MethodsData are from FORWARD, The National Data Bank for Rheumatic Diseases, questionnaires collected from participants with physician-diagnosed SLE and no concomitant RA at 6-month intervals during July 2015 – July 2020. Respondents provided comprehensive health information including GC use and dosage and healthcare use during the prior 6 months. Analyses examined 6-month utilization according to GC use/non-use, as well as by GC dose (0, 1- <5 mg, 5- <10 mg, ≥10 mg). For GC users, data were drawn from the questionnaire in which GCs were first reported during the analysis period. Data for non-users were drawn from the first questionnaire completed during the observation period. Adjusted analyses used double selection LASSO to form the best fitting model considering the following co-variates: age, sex, race, BMI, comorbidities, education level, smoking, SLE duration, self-reported lupus disease activity, SLE organ damage measured by BILD (Brief Index of Lupus Damage), and other medications. Results of LASSO analyses are reported as incidence rate ratios (IRRs).Results512 participants qualified for the analysis; 46.3% reported GC use in at least one 6-month period. Over 90% of the cohort was male, mean age 58 ±13 years, SLE duration 24 ±12 years. GC users were significantly less likely to be male or white, had more comorbidities, had lupus of greater duration, were more likely to also be taking immunosuppressive medications, and reported more active SLE and greater disease damage (BILD). In bivariate analyses (Table 1), GC users reported significantly more rheumatology and other doctor visits, and more PT/OT visits. They also reported more lung function, blood, and urine tests. There was no difference between GC users and non-users in the occurrence of a hospitalization, but users had significantly longer hospitalizations. The multivariable LASSO regression analyses[1]revealed similar results, with significantly IRRs for GC users for rheumatology and other visits, blood and urine tests, and hospitalizations. In analyses based on GC dosage, IRRs for rheumatology visits, other medical visits and blood tests were significantly elevated for each dosage group compared to the no-GC group; the highest GC dosage group also had significantly elevated IRRs for lung and urine tests and hospitalizations.ConclusionGC use is associated with greater healthcare utilization among this cohort with SLE, even after adjusting for a wide range of sociodemographic and disease-related factors. Additional analyses are needed to explore whether greater GC use reflects more severe disease, and/or whether GC use itself leads to increased healthcare utilization.Reference[1] Belloni A, et al. J Economic Perspectives 2014; 28:29Acknowledgements:NIL.Disclosure of InterestsPatti Katz Grant/research support from: Contractor with FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, a health care research organization contracted to support this research, Sofia Pedro Grant/research support from: Employee of FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, a health care research organization contracted to support this research, Jiyoon Choi Employee of: Employee of and may own stock options in Bristol Myers Squibb, Kaleb Michaud Grant/research support from: Employee of FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, a health care research organization contracted to support this research.