Pos1181 Not Yet on Track: Retrospective Chart Analysis Reveals Physician’s Treatment Appoaches in Sle Fall Short of New Eular Guidance

Background: In October 2023, EULAR released updated recommendations for the management of systemic lupus erythematosus (SLE).² Notably, since the previous guidelines update in 2019, anifrolumab received approval for treatment of SLE, and belimumab and voclosporin for lupus nephritis (LN). Objectives: Utilizing the "pre recommendation" audit data, explore approaches employed by rheumatologists in the United States and EU5 countries (France, Germany, Italy, Spain, and United Kingdom) in the management of SLE to uncover the degree to which these already align with the new recommendations outlined by EULAR in 2023. Methods: 1,257 moderate-to-severe (M/S) adult SLE patient records were collected in collaboration with 288 EU5 rheumatologists via an online survey platform from June through July 2023. Further, 1,011 M/S SLE patient records were collected in collaboration with 297 US rheumatologists via an online survey platform from March through May 2023. Results: The first EULAR recommendation states that hydroxychloroquine (HCQ) should be used in all SLE patients, unless contraindicated. Audited patient charts reveal that M/S SLE patients were increasingly initiated on HCQ therapy (compared with 2022) – often perceived and utilized as the foundational agent for SLE. However, there is a substantial discrepancy in HCQ prescription rates between patients in the US and those in the EU5, with a notably higher prevalence evident in the US. Second, EULAR recommends that glucocorticoids (GCs) be lowered to a maintenance daily dose of ≤ 5mg and withdrawn when possible. Audited patient data shows the proportion of SLE patients receiving GCs increased since 2022, to 38% in the US patients and 45% in EU5. Notably, among those receiving oral steroids, only approximately half of audited patients in both US and EU5 are on maintenance doses of ≤ 5mg. That said, the proportion of patients in the US on the recommended lower dose increased by 12 percentage points between 2022 and 2023, without change in EU5. Third, EULAR guidelines recommend rheumatologists should consider adding traditional DMARDs (methotrexate, azathioprine, or mycophenolate mofetil) and/or biologics to patients who fail to respond to HCQ or those who fail to taper to maintenance GC doses of ≤ 5mg. In both US and EU5, there has been a discernible decline in utilization of methotrexate and azathioprine, paralleled by a notable rise in the usage of biologics. The use of mycophenolate mofetil (MMF) increased in both geographies, as this agent is a staple of care in patients with SLE and LN. In both geographies, audited patients who are receiving ≥ 5mg GCs per day are more likely to be prescribed concomitant DMARDs and/or biologics in 2023 compared with 2022, While US patients continued to have higher prescription rates for biologics, the gap narrowed in the EU5 during 2023. Biologic prescriptions were 9 percentage points higher for US than EU5 patients in 2022; that difference dropped to 5 percentage points in 2023. Conclusion: While SLE management practices in the US and EU5 share similarities, there are notable differences, particularly in HCQ and GC use. Importantly, both regions show increasing adoption of biologics, especially for steroid-dependent patients, partially bridging the gap in adherence to the new EULAR recommendations. Future research is needed to understand the drivers of these geographical differences and how physicians globally may optimize their SLE management strategies to better adhere to the new EULAR recommendations. REFERENCES: [1] Fanouriakis A, Kostopoulou M, Andersen J, et al EULAR recommendations for the management of systemic lupus erythematosus: 2023 update. Annals of the Rheumatic Diseases 2024;83:15-29. Acknowledgements: NIL. Disclosure of Interests: None declared.