P145 Global perspectives on glucocorticoid prescribing in systemic lupus erythematosus: results from the LUPHPOS survey

Glucocorticoids play a pivotal role in the management of active SLE; however, their use is associated with the risk of irreversible organ damage. The lack of specific guidelines on steroid use, and the inherent heterogeneity of SLE, pose challenges for glucocorticoids prescribing. This study aimed to explore the variations in prescribing practices and attitudes toward initiating/withdrawing glucocorticoid therapy in SLE, between physicians practicing in European and non-European countries.

The LUPHPOS (LUpus PHysician’ Perspective On glucocorticoidS) study is an online cross-sectional self-reported survey on the physician’s perspective of glucocorticoids in the management of SLE (April-December 2023). Responses were compared between practitioners practicing within Europe, and those practicing outside of Europe.

A total of 501 physicians from 54 countries completed the survey; 269 (54%) from Europe and 232 (46%) from non-European countries. Most respondents (82%) were adult rheumatologists, and 70% worked within a university hospital. Around half (45%) of respondents had a dedicated lupus clinic, which was more common in Europe (51% vs 39%, p = 0.007). The primary factors influencing glucocorticoid dose selection were similar across both groups, with current disease activity (80% vs. 85%) and organ involvement (77% vs. 86%) being the most important. European physicians cited comorbidities (40%) as the third most important factor, whereas non-European physicians prioritised the disease course (34%). When initiating glucocorticoids, a weight-based regimen was used less frequently by European physicians (48% vs 70%, p < 0.001). In severe flares, pulse glucocorticoids was preferred in both groups (75% vs 78%). The commonest dose was 500 mg/day for European physicians (45%), and 1000 mg/day for non-European physicians (37%). In a moderate flare, in those who preferred weight-based dosing, most commonly used doses were 0.25-0.3 mg/kg/day (21% vs 25%) and 0.5mg/kg/day (15% vs 25%). In those preferring fixed-dosing, the most common dose was 15-20 mg/day (18% vs 8%). For mild flares, the majority of European and non-European respondents reported using oral glucocorticoids (77% vs 74%). The commonest doses were 0.25 mg/kg/day (46% vs 33%) or 5-10 mg/day (37% vs 41%), in Europeans compared with non-Europeans. Comparing European and non-European physicians, glucocorticoids withdrawal was most common when patients had been in remission for at least 12 months (41% vs 28%), or on achieving remission (32% vs 27%). European physicians were less likely to agree that glucocorticoids could rarely be withdrawn (5% vs 11%). 51% of European and 48% of non-European physicians agreed that the most acceptable target dose for tapering steroids was ≤5 mg/day; however, Europeans were less likely to find ≤10 mg/day acceptable (3% vs 7%).

Physician location influences glucocorticoid prescribing practices and safety considerations, impacting dosing selection, withdrawal, and tapering strategies. These geographical disparities underscore the need for a consensus on evidence-based care, and global implementation and dissemination strategies.

S. Dyball: Grants/research support; Novartis, UCB. C. Sieiro Santos: None. E. Chessa: None. K. Chandwar: None. M. Mosca: None.