A recent analysis of the SLE Prospective Observational Cohort Study (SPOCS) has provided valuable findings on the real-world treatment patterns and clinical characteristics of patients with moderate-to-severe systemic lupus erythematosus (SLE). This global study, conducted over three years, highlights current trends in medication use and disease management among affected individuals.
The study included patients from diverse clinical settings worldwide and monitored their treatment regimens and disease activity through biannual assessments. Key indicators included the SLE Disease Activity Index 2000 (SLEDAI-2K), oral glucocorticoid use, and the administration of other therapies such as antimalarials, biologics, and immunosuppressants. Additionally, subgroup analyses examined treatment patterns based on baseline interferon gene signature (IFNGS) status and disease severity.
The study revealed that antimalarials were the most commonly prescribed treatment, used by 81.1% of patients, followed by glucocorticoids (65.0%), immunosuppressants (54.8%), and biologics (21.2%). Notably, disease activity, as measured by SLEDAI-2K scores, showed improvement within the first 12 months, decreasing from a median of 8.0 to 4.0, and remained stable thereafter. However, while some aspects of disease control improved, the study found persistent challenges with glucocorticoid use. The mean daily oral glucocorticoid dose increased from 6.0 mg at baseline to 9.8 mg within six months and remained steady. The proportion of patients requiring glucocorticoid doses exceeding 5 mg/day ranged from 20% to 33% throughout the study period. Further analysis revealed that patients with high IFNGS and high disease activity state (HDAS) at baseline were more likely to require immunosuppressants and glucocorticoids compared to those with lower IFNGS and non-HDAS status. This suggests that specific disease subtypes may require more aggressive treatment strategies.
Type I interferons (IFNs) play a key role in SLE, contributing to both disease activity and pathogenesis. Elevated levels of type I IFNs are observed in most SLE patients, with evidence suggesting that many immunological and clinical manifestations stem from their dysregulation or excessive production. Whole blood (IFNGS analyses have revealed overexpression of IFN-α/β-inducible genes in individual patients. Moreover, studies indicate that patients with high IFNGS exhibit greater SLE disease activity and are less likely to achieve treatment targets, such as lupus low disease activity state (LLDAS), compared to those with low IFNGS.
Despite current treatment options, the study underscores that many patients with SLE still do not achieve optimal disease control, as recommended by the European Alliance of Associations for Rheumatology (EULAR). The reliance on glucocorticoids and the persistent disease activity in many patients highlight the need for more effective and targeted therapies. The findings from the SPOCS study emphasize the importance of continued research into novel treatment approaches to better manage SLE and reduce the long-term burden of glucocorticoid use. With emerging therapies under development, there is hope that future treatment strategies will provide improved outcomes for patients living with this challenging autoimmune condition.
Reference
Aringer M, Arnaud L, Furie RA, Morand EF, Peschken C, Hoi A, Desta B, Hedberg J, Grünfeld Eén T, Sorrentino A, Kielar D, Tummala R, Chen S, Ding B. Real-world treatment patterns and clinical characteristics in patients with moderate-to-severe systemic lupus erythematosus: an analysis of the SLE Prospective Observational Cohort Study (SPOCS). Lupus Sci Med. 2025 Jan 23;12(1):e001336.