O3 Physician experience influences glucocorticoid prescribing patterns in systemic lupus erythematosus (SLE): results from the LUPHPOS survey

Objectives To explore the variations in glucocorticoid prescribing practices according to the physician's years of experience in managing SLE. Methods 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, disseminated between April-August 2023. We have compared responses between practitioners with ≤10 years (shorter experience, SE) and those with >10 years of experience (longer experience, LE). Results A weight-based regimen for prescribing glucocorticoids was preferred by both groups, table 1. No differences in glucocorticoid prescribing practices were found in mild and moderate flares. The most common dose was 0.10 mg/kg/day or 5–10 mg/day in mild flares, and 0.25–0.3 mg/kg/day or 15–20 mg/day in moderate flares. In severe flares, pulse therapy was used more often by SE physicians (79% vs 65%, p=0.01). The commonest dose was 500 mg/day for both groups over 3 days. SE physicians more frequently prescribed pulse doses >500 mg/day (41% vs 29%, p=0.02), and pulses for >3 days (24% vs 5%, p<0.001). The most frequently reported target dose for tapering steroids was ≤5mg/day in both groups, however LE physicians targeted 0 mg/day more frequently (22% vs 13%, p=0.04). Steroid withdrawal >12 months after achieving remission/LLDAS was preferred by both groups. Both groups agreed that current disease activity, and type of organ involvement, were the main deciding factors for selecting steroid dose. LE physicians rated comorbidities as their third key driver (39%), whereas SE physicians ranked the course of the disease (44%). There was agreement that infection, cushingoid features, and osteoporosis were the most influencing factors for withdrawing steroids. Conclusions The years of experience influence the use of glucocorticoid therapy in severe flare management, tapering protocols, and steroid withdrawal. These differences underscore the need for wide-reaching dissemination and implementation strategies to ensure the adoption of evidence-based care practices across all levels of clinical experience.