title: Trends in the outpatient medication management of lupus erythematosus in the United States.
abstract: BACKGROUND
  Systemic lupus erythematosus (SLE) and chronic cutaneous lupus (CCLE) therapy has changed little over the past 50 years. In March 2011, the US Food and Drug Administration (FDA) approved belimumab, complementing the three preexisting approved therapies: low dose aspirin, prednisone, and hydroxychloroquine.
  
  
  OBJECTIVE
  The objectives for this study were to evaluate trends in the medications prescribed for the management of lupus erythematosus (LE) and to assess how treatment varies among different specialists.
  
  
  METHODS
  Outpatient visits for treatment of lupus and its comorbidities were identified in the National Ambulatory Medical Care Survey (NAMCS), a representative survey of visits to physician offices in the United States. Data was evaluated to determine patient demographics, treatments prescribed by each specialty, and comorbidities encountered during the study period of 1993-2010.
  
  
  RESULTS
  From 1993-2004, prednisone was the most frequently prescribed medication; however, prednisone became the second most frequently prescribed medication in 2005-2010, as hydroxychloroquine became the leading medication prescribed for LE. In primary care physicians and other non-dermatology specialists, the most frequently prescribed medications for lupus were prednisone and hydroxychloroquine; whereas, hydroxychloroquine and triamcinolone were the top two medications preferred by dermatologists.
  
  
  CONCLUSIONS
  The NAMCS collects cross-sectional data, such that individual patients cannot be followed over time. Hence, it does not provide data regarding the incidence of disease, patient age at the time of diagnosis, change in individual patient's medication regimens over time, or prognosis related to patient demographics. In addition, it is possible that the physician did not always record nonprescription medication use, such as NSAIDS, since these are typically used first line.
  
  
  CONCLUSIONS
  First-line treatment of LE changed minimally from 1993 to 2010, with prednisone and hydroxychloroquine serving as the primary medications utilized by most physicians for the management of LE.
authors.forename: Daniel Y
authors.initials: DY
authors.lastname: Sugai
authors.forename: Cheryl J
authors.initials: CJ
authors.lastname: Gustafson
authors.forename: Jacqueline F
authors.initials: JF
authors.lastname: De Luca
authors.forename: Scott A
authors.initials: SA
authors.lastname: Davis
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Jorizzo
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: O'Rourke
authors.forename: Steven R
authors.initials: SR
authors.lastname: Feldman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008179:Lupus Erythematosus, Discoid / Q000188:drug therapy*; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult