Medication Use for Pediatric Lupus Differs by Race and Insurance Status

Differences in medication use were based on insurance status and race among patients with pediatric systemic lupus erythematosus (pSLE), according to study findings published in ACR Open Rheumatology.

To determine trends in medication use in pSLE, researchers conducted a multicenter retrospective analysis using data from patients with pSLE enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry between 2017 and 2020.

Of the total cohort (N=639), 480 had at least 1 year of follow-up. At study enrollment, 89% of patients were prescribed antimalarial medications and 50% received high-dose glucocorticoids. Within the 1-year follow-up period, 12% of patients received rituximab.


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The most common disease-modifying antirheumatic drugs (DMARDs) included mycophenolate mofetil (82%), cyclophosphamide (31%), and rituximab (28%) in pediatric patients with lupus nephritis (LN), and mycophenolate mofetil (49%), azathioprine (26%), and methotrexate (21%) for those without LN.

Prescription of antimalarial drugs occurred at higher rates in patients with LN and at lower rates in children without insurance. High-dose glucocorticoids correlated with shorter pSLE duration, higher SLE Disease Activity Index (SLEDAI) 2000 scores, and higher rates of prescription for those with LN.

With regard to medication prescription in the different racial and ethnic subgroups, the likelihood of rituximab prescription was higher among Black patients when adjusted for site of care; however, without adjusting for site of care, the Black race was not a significant individual-level predictor for rituximab prescription.

“Site of care was associated with the racial differences observed in rituximab use,” the study authors noted. “Further research is needed to optimize pSLE treatments particularly where use is highly variable, including glucocorticoid dosing and use of rituximab, and understand the impact of practice variation on disparities in pSLE outcomes,” they added.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Roberts JE, Berbert L, Chang J, Son MBF; for the Childhood Arthritis and Rheumatology Research Alliance Registry Investigators. Association of race and ethnicity with medication use for pediatric lupus in the Childhood Arthritis and Rheumatology Research Alliance Registry. ACR Open Rheumatol. Published online August 29, 2022. doi:10.1002/acr2.11494

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