Real-world glucocorticoid prescription patterns in patients with lupus nephritis: A retrospective study using a healthcare insurance claims database

Objective: While oral glucocorticoids (GC) have improved the prognosis of lupus nephritis (LN), dose reduction to ≤5.0 mg/day is recommended, considering their toxicity. We investigated the real-world prescription status following dose reduction of oral GC after starting initial therapy in patients with LN. Methods: Data were extracted from the JMDC insurance claims database between May 2016 and March 2023 with the following inclusion criteria: patients with ≥2 LN diagnoses; follow-up for ≥90 days pre-index and ≥540 days post-index; oral GC dose ≥20.0 mg/day (prednisolone equivalent) or intravenous glucocorticoid pulse; ≥2 urinalyses, anti-double stranded DNA antibody, and complement tests within 360 days post-index. Descriptive analyses were performed by characterization as dose reduction target (GC ≤5.0 mg/day at Day 540) ‘achieved’ or ‘non-achieved’ groups. Results: Mean oral GC baseline dose for the overall population (n = 295) was 36.1 mg/day. The two most prescribed immunosuppressants were mycophenolate mofetil (MMF; 41.7%) and tacrolimus (TAC; 16.9%). The proportion of patients with prescribed GC doses ≤5.0 mg/day was 1.0% on Day 1 and 48.1% on Day 540. In the achieved and non-achieved groups, the baseline concomitant immunosuppressants were MMF: 51.4% and 32.7% and TAC: 15.5% and 18.3%, respectively, while the proportion of patients with GC ≤7.5 mg/day was 31.0% and 12.4% on Day 180, respectively. Conclusion: These real-world administrative data show the actual oral GC prescription status after starting initial LN therapy in Japan. Approximately half of the patients with LN were prescribed GC ≤5.0 mg/day within 1.5 years after starting the initial therapy.