Real-world electronic health record identifies antimalarial underprescribing in patients with lupus nephritis.

Xiong WW, Boone JB, Wheless L, Chung CP, Crofford LJ, Barnado A
Lupus. 2019 28 (8): 977-985

PMID: 31189414 · PMCID: PMC6609095 · DOI:10.1177/0961203319856088

Antimalarials (AMs) reduce disease activity and improve survival in patients with systemic lupus erythematosus (SLE), but studies have reported low AM prescribing frequencies. Using a real-world electronic health record cohort, we examined if patient or provider characteristics impacted AM prescribing. We identified 977 SLE cases, 94% of whom were ever prescribed an AM. Older patients and patients with SLE nephritis were less likely to be on AMs. Current age (odds ratio = 0.97,  < 0.01) and nephritis (odds ratio = 0.16,  < 0.01) were both significantly associated with ever AM use after adjustment for sex and race. Of the 244 SLE nephritis cases, only 63% were currently on AMs. SLE nephritis subjects who were currently prescribed AMs were more likely to be followed by a rheumatologist than a nephrologist and less likely to have undergone dialysis or renal transplant (both  < 0.001). Non-current versus current SLE nephritis AM users had higher serum creatinine ( < 0.001), higher urine protein ( = 0.05), and lower hemoglobin levels ( < 0.01). As AMs reduce disease damage and improve survival in patients with SLE, our results demonstrate an opportunity to target future efforts to improve prescribing rates among multi-specialty providers.

MeSH Terms (16)

Adult Aged Antimalarials Cohort Studies Creatinine Cross-Sectional Studies Electronic Health Records Female Humans Logistic Models Lupus Erythematosus, Systemic Lupus Nephritis Male Middle Aged Severity of Illness Index United States

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