P152 Exploring global discrepancies in systemic lupus erythematosus treatment

Objective Globally, there is an absence of standardised protocols for the treatment of SLE. This study aimed to conduct a worldwide evaluation of treatment, including the use of steroids, conventional DMARDs and biologic agents in SLE. Additionally, we sought to explore the impact of the Human Development Index (HDI) on regional variations in therapy. Methods Data from the COVID-19 database including patient demographics and treatments was grouped by continent. Data collection included demographics and current treatment including; corticosteroids (CS), antimalarials, conventional DMARDs, cyclophosphamide and biologics (rituximab and belimumab). Analysis of treatment variations across regions was assessed by individual country HDI, a composite index formulated by the United Nations to rank countries into tiers of development. Statistical analysis comprised of Chi square for categorical values and t-test for comparison between groups. Results The study included 1292 patients across six continents, with Asia and Europe having higher enrolment. Demographic details and treatment are summarised in table 1. Prescribing patterns are summarised in figure 1. Europe and North America showed lower steroid usage. Hydroxychloroquine was globally prevalent for SLE treatment, however was lowest in Europe (53%) and highest in Oceania (80%). Tacrolimus usage was significantly higher in South America, along with increased use of Mycophenolate. Azathioprine was more frequently used in North America and Africa. Cyclophosphamide was notably utilised more frequently in Asia (3%) and South America (3%). Rituximab use was lower in Europe compared to Africa and South America, whilst Belimumab was not administered to patients in Asia and Africa included in the study. When evaluating HDI, Hydroxychloroquine use was more often used in patients from low/medium HDI than in those from high/very high HDI (81% vs 68%, p=0.002). Similarly, conventional DMARDs were more commonly used in low/medium HDI than high/very high HDI (68% vs 56%, p=0.0009). In comparison, biologic use was more frequent in high/very high HDI countries (7% vs 2%, p=0.005). Conclusions This study highlights significant regional treatment differences both globally and within continents when evaluating HDI. Further analysis is required to better understand the factors associated with choice of therapeutic agents at regional and continental level. Declaration of Interest ALT has received honoraria for advisory boards and speaking for Abbvie, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB. EN has received speaker honoraria/participated in advisory boards for Celltrion, Pfizer, Sanofi, Gilead, Galapagos, AbbVie, and Lilly, and holds research grants from Pfizer and Lilly. IP has received research funding and/or honoraria from Amgen, AstraZeneca, Aurinia Pharmaceuticals, Elli Lilly and Company, Gilead Sciences, GlaxoSmithKline, Janssen Pharmaceuticals, Novartis and F. Hoffmann-La Roche AG. JBL has received speaker honoraria/participated in advisory boards for Sanofi Genzyme, Roche, and Biogen. None is related to this manuscript. JD has received research funding from CSL Limited. NZ has received speaker fees, advisory board fees, and research grants from Pfizer, Roche, Abbvie, Eli Lilly, NewBridge, Sanofi-Aventis, Boehringer Ingelheim, Janssen, and Pierre Fabre; none are related to this manuscript. RA has a consultancy relationship with and/or has received research funding from the following companies: Bristol Myers-Squibb, Pfizer, Genentech, Octapharma, CSL Behring, Mallinckrodt, AstraZeneca, Corbus, Kezar, Abbvie, Janssen, Kyverna Alexion, Argenx, Q32, EMD-Serono, Boehringer Ingelheim, Roivant, Merck, Galapagos, Actigraph, Scipher, Horizon Therapeutics, Teva, Beigene, ANI Pharmaceuticals, Biogen, Nuvig, Capella Bioscience, and CabalettaBio. Rest of the authors have no conflict of interest relevant to this manuscript.