Journal
LUPUS
Volume 28, Issue 8, Pages 977-985Publisher
SAGE PUBLICATIONS LTD
DOI: 10.1177/0961203319856088
Keywords
Systemic lupus erythematosus; electronic health records; antimalarials; lupus nephritis
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Funding
- National Institutes of Health/National Institute of Child Health and Human Development [5K12HD043483-12]
- National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases [1 K08AR07 2757-01, K23AR064768]
- National Institutes of Health/National Institute of General Medical Sciences [R01 GM126535]
- Rheumatology Research Foundation K Supplement
- Vanderbilt University Medical Center (NCRR/NIH) [UL1 RR024975]
- Vanderbilt University Medical Center (NCATS/NIH) [ULTR000445]
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Antimalarials (AMs) reduce disease activity and improve survival in patients with systemic lupus erythematosus (SLE), but studies have reported low AM prescribing frequencies. Using a real-world electronic health record cohort, we examined if patient or provider characteristics impacted AM prescribing. We identified 977 SLE cases, 94% of whom were ever prescribed an AM. Older patients and patients with SLE nephritis were less likely to be on AMs. Current age (odds ratio = 0.97, p < 0.01) and nephritis (odds ratio = 0.16, p < 0.01) were both significantly associated with ever AM use after adjustment for sex and race. Of the 244 SLE nephritis cases, only 63% were currently on AMs. SLE nephritis subjects who were currently prescribed AMs were more likely to be followed by a rheumatologist than a nephrologist and less likely to have undergone dialysis or renal transplant (both p < 0.001). Non-current versus current SLE nephritis AM users had higher serum creatinine (p < 0.001), higher urine protein (p = 0.05), and lower hemoglobin levels (p < 0.01). As AMs reduce disease damage and improve survival in patients with SLE, our results demonstrate an opportunity to target future efforts to improve prescribing rates among multi-specialty providers.
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