title: Patterns of drug therapy in newly diagnosed Spanish patients with systemic lupus erythematosus.
abstract: OBJECTIVE
  This is the first Spanish multicentric inception lupus cohort, formed by SLE patients attending Spanish Internal Medicine Services since January 2009. We aimed to analyse drug therapy during the first year of follow-up according to disease severity.
  
  
  METHODS
  223 patients who had at least one year of follow-up were enrolled upon diagnosis of SLE. Therapy with prednisone, pulse methyl-prednisolone, hydroxychloroquine, immunosuppressives and calcium/vitamin D was analysed.
  
  
  RESULTS
  Prednisone was given to 65% patients, at a mean (SD) daily dose of 11 (10) mg/d. 38% patients received average doses >7.5 mg/d during the first year. Patients with nephritis and with a SLEDAI ≥6 were treated with higher doses of prednisone. 81% of patients were treated with hydroxychloroquine, with higher frequency among those with a SLEDAI ≥6 (88% vs. 68%, p<0.001). The use of immunosuppressive drugs and methyl-prednisolone pulses was higher in patients with a baseline SLEDAI ≥6, however, differences were no longer significant when patients with lupus nephritis were excluded. The use of calcium/vitamin D increased with the dose of prednisone, however, 43% of patients on medium-high doses of prednisone did not take any calcium or vitamin D.
  
  
  CONCLUSIONS
  This study gives a real-world view of the current therapeutic approach to early lupus in Spain. The generalised use of hydroxychloroquine is well consolidated. There is still a tendency to use prednisone at medium to high doses. Pulse methyl-prednisolone and immunosuppressive drugs were used in more severe cases, but not as steroid sparing agents. Vitamin D use was suboptimal.
authors.affiliation: Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Bizkaia, Spain. r.irastorza@outlook.es.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ruiz-Irastorza
authors.affiliation: Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Bizkaia, Spain.
authors.forename: Miriam
authors.initials: M
authors.lastname: García
authors.affiliation: Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain.
authors.forename: Gerard
authors.initials: G
authors.lastname: Espinosa
authors.affiliation: Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Ivan
authors.initials: I
authors.lastname: Cabezas-Rodríguez
authors.affiliation: Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Francesca
authors.initials: F
authors.lastname: Mitjavila
authors.affiliation: Department of Internal Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Rocío
authors.initials: R
authors.lastname: González-León
authors.affiliation: Department of Internal Medicine, Complejo Hospitalario Universitario de Vigo, Spain.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Sopeña
authors.affiliation: Department of Internal Medicine, Hospital Universitario Fuenlabrada, Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Perales
authors.affiliation: Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Blanca
authors.initials: B
authors.lastname: Pinilla
authors.affiliation: Department of Internal Medicine, Hospital Universitario Mutua de Terrasa, Barcelona, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Rodríguez-Carballeira
authors.affiliation: Department of Internal Medicine, Hospital Universitario Joan XXIII, Tarragona, Spain.
authors.forename: Jesús Miguel
authors.initials: JM
authors.lastname: López-Dupla
authors.affiliation: Department of Internal Medicine, Hospital Universitario San Cecilio, Granada, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Callejas
authors.affiliation: Department of Internal Medicine, Hospital Universitario Sant Joan de Reus, Tarragona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Castro
authors.affiliation: Department of Internal Medicine, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain.
authors.forename: Carles
authors.initials: C
authors.lastname: Tolosa
authors.affiliation: Department of Internal Medicine, Autoimmune Diseases Unit, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: María Esther
authors.initials: ME
authors.lastname: Sánchez-García
authors.affiliation: Department of Internal Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Pérez-Conesa
authors.affiliation: Department of Internal Medicine, Hospital Universitario Virgen de las Nieves, Granada, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Navarrete-Navarrete
authors.affiliation: Department of Internal Medicine, Complejo Hospitalario Universitario de Ourense, Spain.
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Rodríguez
authors.affiliation: Department of Internal Medicine, Hospital J.M. Morales Meseguer, Murcia, Spain.
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Herranz
authors.affiliation: Department of Internal Medicine, Hospital Universitario Son Espases, Palma de Mallorca, Spain.
authors.forename: Lucio
authors.initials: L
authors.lastname: Pallarés
mesh_terms: D000328:Adult; D002118:Calcium / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D054539:Medication Therapy Management / Q000706:statistics & numerical data; D008875:Middle Aged; D062072:Patient Acuity; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011241:Prednisone / Q000627:therapeutic use*; D013030:Spain / Q000453:epidemiology; D063189:Symptom Assessment; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D014807:Vitamin D; D006886:Hydroxychloroquine; D002118:Calcium; D011241:Prednisone