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

Michele Iudici; Denis Mongin; Elise Siegert; Patricia E. Carreira; Jörg Distler; Jörg Henes; Elisabetta Zanatta; Eric Hachulla; Giacomo De Luca; Carolina De Souza Müller; Tânia Santiago; Jose Luis Tandaipan; Breno Valdetaro Bianchi; Maria De Santis; Anna Maria Hoffmann-Vold; Armando Gabrielli; Oliver Distler; Delphine Sophie Courvoisier; Giovanna Cuomo; Gianluca Moroncini; Jiri Stork; Fiorenzo Iannone; Ulrich Walker; Eugenia Bertoldo; Dorota Krasowska; Maria João Salvador; Mohammed Tikly; Valeria Riccieri; Ami Sha; Ana Maria Gheorghiu; Cord Sunderkötter; Francesca Ingegnoli; Luc Mouthon; Vanessa Smith; Francesco Paolo Cantatore; Kilian Eyerich; Piotr Wiland; Marie Vanthuyne; Branimir Anic; Maria Üprus; Brigitte Granel; Alessandra Vacca; Cristina Mihaela Tanaseanu; Paloma García de la Peña Lefebvre; Jean Sibilia; Ira Litinsky; Lesley Ann Saketkoo; Eduardo Kerzberg; Massimiliano Limonta; Doron Rimar; Petros Sfikakis; Maurizio Cutolo; Rosario Foti; Srdan Novak; Mislav Radic; Raffaele Pellerito; Carlo Francesco Selmi Rozzano; Lidia P. Ananieva; Gabriela Szucs; Carlos De La Puente; Ruxandra Maria Ionescu; Maria Rosa Pozzi; Juan Jose Alegre-Sancho; Kristine Herrmann; Ellen De Langhe; Sule Yavuz Altunizade; Svetlana Agachi; Douglas Veale; Esthela Loyo; Mengtao Li; Edoardo Rosato; Britta Maurer; Iván Castellví; François Spertini; Kamal Solanki; Nicoletta Del Papa; Gerard Espinosa; László Czirják; Bernard Coleiro; Dominique Farge Bancel; Raffaele Pellerito; Christopher Denton; Nemanja Damjanov; Vera Ortiz Santamaria Granollers; Michaela Kohm; Bojana Stamenkovic; Yannick Allanore; Paolo Airo'; Alexandra Balbir-Gurman; Marco Matucci Cerinic; Gabriela Riemekasten; Stefan Heitmann; Nicolas Hunzelmann; Carlomaurizio Montecucco; Jadranka Morovic-Vergles; Camillo Ribi

doi:10.1093/rheumatology/keac533

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

Michele Iudici^*, Denis Mongin, Elise Siegert, Patricia E. Carreira, Jörg Distler, Jörg Henes, Elisabetta Zanatta, Eric Hachulla, Giacomo De Luca, Carolina De Souza Müller, Tânia Santiago, Jose Luis Tandaipan, Breno Valdetaro Bianchi, Maria De Santis, Anna Maria Hoffmann-Vold, Armando Gabrielli, Oliver Distler, Delphine Sophie Courvoisier, Giovanna Cuomo, Gianluca MoronciniJiri Stork, Fiorenzo Iannone, Ulrich Walker, Eugenia Bertoldo, Dorota Krasowska, Maria João Salvador, Mohammed Tikly, Valeria Riccieri, Ami Sha, Ana Maria Gheorghiu, Cord Sunderkötter, Francesca Ingegnoli, Luc Mouthon, Vanessa Smith, Francesco Paolo Cantatore, Kilian Eyerich, Piotr Wiland, Marie Vanthuyne, Branimir Anic, Maria Üprus, Brigitte Granel, Alessandra Vacca, Cristina Mihaela Tanaseanu, Paloma García de la Peña Lefebvre, Jean Sibilia, Ira Litinsky, Lesley Ann Saketkoo, Eduardo Kerzberg, Massimiliano Limonta, Doron Rimar, Petros Sfikakis, Maurizio Cutolo, Rosario Foti, Srdan Novak, Mislav Radic, Raffaele Pellerito, Carlo Francesco Selmi Rozzano, Lidia P. Ananieva, Gabriela Szucs, Carlos De La Puente, Ruxandra Maria Ionescu, Maria Rosa Pozzi, Juan Jose Alegre-Sancho, Kristine Herrmann, Ellen De Langhe, Sule Yavuz Altunizade, Svetlana Agachi, Douglas Veale, Esthela Loyo, Mengtao Li, Edoardo Rosato, Britta Maurer, Iván Castellví, François Spertini, Kamal Solanki, Nicoletta Del Papa, Gerard Espinosa, László Czirják, Bernard Coleiro, Dominique Farge Bancel, Raffaele Pellerito, Christopher Denton, Nemanja Damjanov, Vera Ortiz Santamaria Granollers, Michaela Kohm, Bojana Stamenkovic, Yannick Allanore, Paolo Airo', Alexandra Balbir-Gurman, Marco Matucci Cerinic, Gabriela Riemekasten, Stefan Heitmann, Nicolas Hunzelmann, Carlomaurizio Montecucco, Jadranka Morovic-Vergles, Camillo Ribi

^*Corresponding author for this work

Internal Medicine

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Objectives: To estimate the prevalence of long-term exposure to glucocorticoids (GCs) and to identify factors associated with, and variations in prescribing practices over time and across recruiting countries. Methods: We included patients with SSc having a visit recorded in the EUSTAR database from January 2013 onward. We analysed the prevalence and the main features of GCs users, their exposure to GCs over time, and their GCs dosages. Multivariable linear regression was used to analyse the factors identified as associated with GCs intake duration. Time trends, and variations in GCs utilization across recruiting countries were explored. Missing data were imputed using multiple imputation with chained equations. Results: The 9819 patients included were mostly females (85%), the majority had lcSSc (73%), and the median age was 58 years. At baseline, 34% of patients (n = 2769/8109) (48% dcSSc vs 29% lcSSc) were on GCs, and the median dose was 7.5 mg/day. GCs users were more frequently males and anti-Scl70 positive, and more commonly had dcSSc and more severe disease. On average, GCs users spent 25% of their follow-up time (median 33.2 months) on GCs, with no significant between-subsets difference. Notably, 33% (n = 971/2959) and 22% (n = 647/2959) of patients followed up for >1 year had received GCs for >6 and >12 months, respectively. Multivariable analysis showed that patient and disease characteristics poorly explained the variability in GCs exposure (adjusted-R2 = 0.06, P < 0.001). GCs utilization varied within and across countries, and gradually decreased over time (36% in 2013 vs 23% in 2018). Conclusions: GCs are widely and long-term prescribed in SSc, with significant between-countries and within-country differences. A gradual decrease in their utilization has been observed.

Original language	English
Pages (from-to)	1559-1567
Number of pages	9
Journal	Rheumatology
Volume	62
Issue number	4
DOIs	https://doi.org/10.1093/rheumatology/keac533
State	Published - 1 Apr 2023

Keywords

SSc
epidemiology
glucocorticoids

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10.1093/rheumatology/keac533

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Iudici, M., Mongin, D., Siegert, E., Carreira, P. E., Distler, J., Henes, J., Zanatta, E., Hachulla, E., De Luca, G., De Souza Müller, C., Santiago, T., Tandaipan, J. L., Valdetaro Bianchi, B., De Santis, M., Hoffmann-Vold, A. M., Gabrielli, A., Distler, O., Courvoisier, D. S., Cuomo, G., ... Ribi, C. (2023). Glucocorticoids prescribing practices in systemic sclerosis: an analysis of the EUSTAR database. Rheumatology, 62(4), 1559-1567. https://doi.org/10.1093/rheumatology/keac533

@article{81877ccc07db422eb82cf655b1af501c,

title = "Glucocorticoids prescribing practices in systemic sclerosis: an analysis of the EUSTAR database",

abstract = "Objectives: To estimate the prevalence of long-term exposure to glucocorticoids (GCs) and to identify factors associated with, and variations in prescribing practices over time and across recruiting countries. Methods: We included patients with SSc having a visit recorded in the EUSTAR database from January 2013 onward. We analysed the prevalence and the main features of GCs users, their exposure to GCs over time, and their GCs dosages. Multivariable linear regression was used to analyse the factors identified as associated with GCs intake duration. Time trends, and variations in GCs utilization across recruiting countries were explored. Missing data were imputed using multiple imputation with chained equations. Results: The 9819 patients included were mostly females (85%), the majority had lcSSc (73%), and the median age was 58 years. At baseline, 34% of patients (n = 2769/8109) (48% dcSSc vs 29% lcSSc) were on GCs, and the median dose was 7.5 mg/day. GCs users were more frequently males and anti-Scl70 positive, and more commonly had dcSSc and more severe disease. On average, GCs users spent 25% of their follow-up time (median 33.2 months) on GCs, with no significant between-subsets difference. Notably, 33% (n = 971/2959) and 22% (n = 647/2959) of patients followed up for >1 year had received GCs for >6 and >12 months, respectively. Multivariable analysis showed that patient and disease characteristics poorly explained the variability in GCs exposure (adjusted-R2 = 0.06, P < 0.001). GCs utilization varied within and across countries, and gradually decreased over time (36% in 2013 vs 23% in 2018). Conclusions: GCs are widely and long-term prescribed in SSc, with significant between-countries and within-country differences. A gradual decrease in their utilization has been observed.",

keywords = "SSc, epidemiology, glucocorticoids",

author = "Michele Iudici and Denis Mongin and Elise Siegert and Carreira, {Patricia E.} and J{\"o}rg Distler and J{\"o}rg Henes and Elisabetta Zanatta and Eric Hachulla and {De Luca}, Giacomo and {De Souza M{\"u}ller}, Carolina and T{\^a}nia Santiago and Tandaipan, {Jose Luis} and {Valdetaro Bianchi}, Breno and {De Santis}, Maria and Hoffmann-Vold, {Anna Maria} and Armando Gabrielli and Oliver Distler and Courvoisier, {Delphine Sophie} and Giovanna Cuomo and Gianluca Moroncini and Jiri Stork and Fiorenzo Iannone and Ulrich Walker and Eugenia Bertoldo and Dorota Krasowska and Salvador, {Maria Jo{\~a}o} and Mohammed Tikly and Valeria Riccieri and Ami Sha and Gheorghiu, {Ana Maria} and Cord Sunderk{\"o}tter and Francesca Ingegnoli and Luc Mouthon and Vanessa Smith and Cantatore, {Francesco Paolo} and Kilian Eyerich and Piotr Wiland and Marie Vanthuyne and Branimir Anic and Maria {\"U}prus and Brigitte Granel and Alessandra Vacca and Tanaseanu, {Cristina Mihaela} and Lefebvre, {Paloma Garc{\'i}a de la Pe{\~n}a} and Jean Sibilia and Ira Litinsky and Saketkoo, {Lesley Ann} and Eduardo Kerzberg and Massimiliano Limonta and Doron Rimar and Petros Sfikakis and Maurizio Cutolo and Rosario Foti and Srdan Novak and Mislav Radic and Raffaele Pellerito and Rozzano, {Carlo Francesco Selmi} and Ananieva, {Lidia P.} and Gabriela Szucs and {De La Puente}, Carlos and Ionescu, {Ruxandra Maria} and Pozzi, {Maria Rosa} and Alegre-Sancho, {Juan Jose} and Kristine Herrmann and {De Langhe}, Ellen and Altunizade, {Sule Yavuz} and Svetlana Agachi and Douglas Veale and Esthela Loyo and Mengtao Li and Edoardo Rosato and Britta Maurer and Iv{\'a}n Castellv{\'i} and Fran{\c c}ois Spertini and Kamal Solanki and {Del Papa}, Nicoletta and Gerard Espinosa and L{\'a}szl{\'o} Czirj{\'a}k and Bernard Coleiro and Bancel, {Dominique Farge} and Raffaele Pellerito and Christopher Denton and Nemanja Damjanov and Granollers, {Vera Ortiz Santamaria} and Michaela Kohm and Bojana Stamenkovic and Yannick Allanore and Paolo Airo' and Alexandra Balbir-Gurman and Cerinic, {Marco Matucci} and Gabriela Riemekasten and Stefan Heitmann and Nicolas Hunzelmann and Carlomaurizio Montecucco and Jadranka Morovic-Vergles and Camillo Ribi",

year = "2023",

month = apr,

day = "1",

doi = "10.1093/rheumatology/keac533",

language = "אנגלית",

volume = "62",

pages = "1559--1567",

journal = "Rheumatology",

issn = "1462-0324",

publisher = "Oxford University Press",

number = "4",

}

Iudici, M, Mongin, D, Siegert, E, Carreira, PE, Distler, J, Henes, J, Zanatta, E, Hachulla, E, De Luca, G, De Souza Müller, C, Santiago, T, Tandaipan, JL, Valdetaro Bianchi, B, De Santis, M, Hoffmann-Vold, AM, Gabrielli, A, Distler, O, Courvoisier, DS, Cuomo, G, Moroncini, G, Stork, J, Iannone, F, Walker, U, Bertoldo, E, Krasowska, D, Salvador, MJ, Tikly, M, Riccieri, V, Sha, A, Gheorghiu, AM, Sunderkötter, C, Ingegnoli, F, Mouthon, L, Smith, V, Cantatore, FP, Eyerich, K, Wiland, P, Vanthuyne, M, Anic, B, Üprus, M, Granel, B, Vacca, A, Tanaseanu, CM, Lefebvre, PGDLP, Sibilia, J, Litinsky, I, Saketkoo, LA, Kerzberg, E, Limonta, M, Rimar, D, Sfikakis, P, Cutolo, M, Foti, R, Novak, S, Radic, M, Pellerito, R, Rozzano, CFS, Ananieva, LP, Szucs, G, De La Puente, C, Ionescu, RM, Pozzi, MR, Alegre-Sancho, JJ, Herrmann, K, De Langhe, E, Altunizade, SY, Agachi, S, Veale, D, Loyo, E, Li, M, Rosato, E, Maurer, B, Castellví, I, Spertini, F, Solanki, K, Del Papa, N, Espinosa, G, Czirják, L, Coleiro, B, Bancel, DF, Pellerito, R, Denton, C, Damjanov, N, Granollers, VOS, Kohm, M, Stamenkovic, B, Allanore, Y, Airo', P, Balbir-Gurman, A, Cerinic, MM, Riemekasten, G, Heitmann, S, Hunzelmann, N, Montecucco, C, Morovic-Vergles, J & Ribi, C 2023, 'Glucocorticoids prescribing practices in systemic sclerosis: an analysis of the EUSTAR database', Rheumatology, vol. 62, no. 4, pp. 1559-1567. https://doi.org/10.1093/rheumatology/keac533

TY - JOUR

T1 - Glucocorticoids prescribing practices in systemic sclerosis

T2 - an analysis of the EUSTAR database

AU - Iudici, Michele

AU - Mongin, Denis

AU - Siegert, Elise

AU - Carreira, Patricia E.

AU - Distler, Jörg

AU - Henes, Jörg

AU - Zanatta, Elisabetta

AU - Hachulla, Eric

AU - De Luca, Giacomo

AU - De Souza Müller, Carolina

AU - Santiago, Tânia

AU - Tandaipan, Jose Luis

AU - Valdetaro Bianchi, Breno

AU - De Santis, Maria

AU - Hoffmann-Vold, Anna Maria

AU - Gabrielli, Armando

AU - Distler, Oliver

AU - Courvoisier, Delphine Sophie

AU - Cuomo, Giovanna

AU - Moroncini, Gianluca

AU - Stork, Jiri

AU - Iannone, Fiorenzo

AU - Walker, Ulrich

AU - Bertoldo, Eugenia

AU - Krasowska, Dorota

AU - Salvador, Maria João

AU - Tikly, Mohammed

AU - Riccieri, Valeria

AU - Sha, Ami

AU - Gheorghiu, Ana Maria

AU - Sunderkötter, Cord

AU - Ingegnoli, Francesca

AU - Mouthon, Luc

AU - Smith, Vanessa

AU - Cantatore, Francesco Paolo

AU - Eyerich, Kilian

AU - Wiland, Piotr

AU - Vanthuyne, Marie

AU - Anic, Branimir

AU - Üprus, Maria

AU - Granel, Brigitte

AU - Vacca, Alessandra

AU - Tanaseanu, Cristina Mihaela

AU - Lefebvre, Paloma García de la Peña

AU - Sibilia, Jean

AU - Litinsky, Ira

AU - Saketkoo, Lesley Ann

AU - Kerzberg, Eduardo

AU - Limonta, Massimiliano

AU - Rimar, Doron

AU - Sfikakis, Petros

AU - Cutolo, Maurizio

AU - Foti, Rosario

AU - Novak, Srdan

AU - Radic, Mislav

AU - Pellerito, Raffaele

AU - Rozzano, Carlo Francesco Selmi

AU - Ananieva, Lidia P.

AU - Szucs, Gabriela

AU - De La Puente, Carlos

AU - Ionescu, Ruxandra Maria

AU - Pozzi, Maria Rosa

AU - Alegre-Sancho, Juan Jose

AU - Herrmann, Kristine

AU - De Langhe, Ellen

AU - Altunizade, Sule Yavuz

AU - Agachi, Svetlana

AU - Veale, Douglas

AU - Loyo, Esthela

AU - Li, Mengtao

AU - Rosato, Edoardo

AU - Maurer, Britta

AU - Castellví, Iván

AU - Spertini, François

AU - Solanki, Kamal

AU - Del Papa, Nicoletta

AU - Espinosa, Gerard

AU - Czirják, László

AU - Coleiro, Bernard

AU - Bancel, Dominique Farge

AU - Pellerito, Raffaele

AU - Denton, Christopher

AU - Damjanov, Nemanja

AU - Granollers, Vera Ortiz Santamaria

AU - Kohm, Michaela

AU - Stamenkovic, Bojana

AU - Allanore, Yannick

AU - Airo', Paolo

AU - Balbir-Gurman, Alexandra

AU - Cerinic, Marco Matucci

AU - Riemekasten, Gabriela

AU - Heitmann, Stefan

AU - Hunzelmann, Nicolas

AU - Montecucco, Carlomaurizio

AU - Morovic-Vergles, Jadranka

AU - Ribi, Camillo

PY - 2023/4/1

Y1 - 2023/4/1

N2 - Objectives: To estimate the prevalence of long-term exposure to glucocorticoids (GCs) and to identify factors associated with, and variations in prescribing practices over time and across recruiting countries. Methods: We included patients with SSc having a visit recorded in the EUSTAR database from January 2013 onward. We analysed the prevalence and the main features of GCs users, their exposure to GCs over time, and their GCs dosages. Multivariable linear regression was used to analyse the factors identified as associated with GCs intake duration. Time trends, and variations in GCs utilization across recruiting countries were explored. Missing data were imputed using multiple imputation with chained equations. Results: The 9819 patients included were mostly females (85%), the majority had lcSSc (73%), and the median age was 58 years. At baseline, 34% of patients (n = 2769/8109) (48% dcSSc vs 29% lcSSc) were on GCs, and the median dose was 7.5 mg/day. GCs users were more frequently males and anti-Scl70 positive, and more commonly had dcSSc and more severe disease. On average, GCs users spent 25% of their follow-up time (median 33.2 months) on GCs, with no significant between-subsets difference. Notably, 33% (n = 971/2959) and 22% (n = 647/2959) of patients followed up for >1 year had received GCs for >6 and >12 months, respectively. Multivariable analysis showed that patient and disease characteristics poorly explained the variability in GCs exposure (adjusted-R2 = 0.06, P < 0.001). GCs utilization varied within and across countries, and gradually decreased over time (36% in 2013 vs 23% in 2018). Conclusions: GCs are widely and long-term prescribed in SSc, with significant between-countries and within-country differences. A gradual decrease in their utilization has been observed.

AB - Objectives: To estimate the prevalence of long-term exposure to glucocorticoids (GCs) and to identify factors associated with, and variations in prescribing practices over time and across recruiting countries. Methods: We included patients with SSc having a visit recorded in the EUSTAR database from January 2013 onward. We analysed the prevalence and the main features of GCs users, their exposure to GCs over time, and their GCs dosages. Multivariable linear regression was used to analyse the factors identified as associated with GCs intake duration. Time trends, and variations in GCs utilization across recruiting countries were explored. Missing data were imputed using multiple imputation with chained equations. Results: The 9819 patients included were mostly females (85%), the majority had lcSSc (73%), and the median age was 58 years. At baseline, 34% of patients (n = 2769/8109) (48% dcSSc vs 29% lcSSc) were on GCs, and the median dose was 7.5 mg/day. GCs users were more frequently males and anti-Scl70 positive, and more commonly had dcSSc and more severe disease. On average, GCs users spent 25% of their follow-up time (median 33.2 months) on GCs, with no significant between-subsets difference. Notably, 33% (n = 971/2959) and 22% (n = 647/2959) of patients followed up for >1 year had received GCs for >6 and >12 months, respectively. Multivariable analysis showed that patient and disease characteristics poorly explained the variability in GCs exposure (adjusted-R2 = 0.06, P < 0.001). GCs utilization varied within and across countries, and gradually decreased over time (36% in 2013 vs 23% in 2018). Conclusions: GCs are widely and long-term prescribed in SSc, with significant between-countries and within-country differences. A gradual decrease in their utilization has been observed.

KW - SSc

KW - epidemiology

KW - glucocorticoids

UR - http://www.scopus.com/inward/record.url?scp=85152156677&partnerID=8YFLogxK

U2 - 10.1093/rheumatology/keac533

DO - 10.1093/rheumatology/keac533

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C2 - 36099040

AN - SCOPUS:85152156677

SN - 1462-0324

VL - 62

SP - 1559

EP - 1567

JO - Rheumatology

JF - Rheumatology

IS - 4

ER -

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

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