Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Underuse of Hydroxychloroquine among Patients with Systemic Lupus Erythematosus.
Hersh2, Aimee O., Shapiro3, Daniel J., Yelin4, Edward H., Schmajuk1, Gabriela
Recent literature supports the routine use of hydroxychloroquine (HCQ) in the management of systemic lupus erythematosus (SLE), with evidence for reduced disease activity, lower rates of renal progression, better lipid profiles, and improved survival. The extent to which patients with SLE receive HCQ nationwide is unknown. The purpose of this study was to determine the frequency and factors associated with HCQ prescribing in a nationally representative sample of patients with SLE.
We examined HCQ use among ambulatory visits for patients with SLE (ICD-484-CM code 710.0) using the National Ambulatory and National Hospital Ambulatory Medical Care Surveys. These surveys record information about treatments provided among a nationally representative sample of patient visits to ambulatory settings. The primary outcome was HCQ use; this was defined as either new or continued HCQ prescription associated with each incident visit. Continued medications include those previously prescribed by other physicians (i.e. HCQ by a rheumatologist when the incident visit is to a primary care physician). Independent variables included patient demographics (age, gender, race/ethnicity), insurance status (private versus public), steroid use (as a marker of disease activity), physician specialty (rheumatologist versus other), and geographic region. Multivariable logistic regression was performed to identify factors independently associated with receipt of HCQ.
Between 19982007, there was an average of 975,000 ambulatory visits for SLE per year. Hydroxychloroquine was prescribed for 32% (95% CI 24.140) of patients with SLE seen during these visits. Ninety percent of patients were female, 24% were non-white, mean age was 49 years, 54% had private insurance, and 39% received corticosteroids. In bivariate analyses, there were no differences in HCQ use based on patient age, race, gender, insurance status, steroid use or geographic region. HCQ prescribing was higher among visits to rheumatologists versus other physicians (51 vs. 17%, p= 0.0001). In a multivariable analysis, after adjusting for potential confounders, the only factor independently associated with HCQ use was a visit to a rheumatologist (OR 4.57, 95% CI 1.8011.56).
Hydroxycholoroquine use was suboptimal in this national sample of SLE patients. Given recent evidence about the beneficial effects of HCQ on survival in SLE, interventions are needed to increase HCQ use, particularly among those patients seen by non-rheumatologists.
To cite this abstract, please use the following information:
Hersh, Aimee O., Shapiro, Daniel J., Yelin, Edward H., Schmajuk, Gabriela; Underuse of Hydroxychloroquine among Patients with Systemic Lupus Erythematosus. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :484