Clinical Pharmacological Management Status of Systemic Lupus Erythematous Population: Situational Analysis

Abstract

Introduction: Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that has various manifestations among different populations. This study aims to provide an overview of medical pharmacological management that SLE population received immediately at time of diagnosis. Method: This is a retrospective analysis using patients’ registry medical information system. All patients diagnosed with SLE were reviewed by accessing their medical records including pharmacy prescription and dispersions at the Royal hospital from 2006 to 2014. The following comorbidities were analyzed: diabetes mellitus (DM), hypertension (HTN), hyperlipidemia, lung disease, cardiovascular disease (CVD), cerebrovascular accident (CVA), chronic kidney disease (CKD), end-stage kidney disease (ESKD), infections, thyroid disease, malignancy, and miscarriages. Results: There were 966 patients diagnosed with SLE during the period from 2006 to 2014. The Mean (SD) of age at presentation was 35.5 (11.5) years. Most patients were female (88.7%) with mean age of 27.6 (1.4) years. Unsurprisingly anti-malarial drug, hydroxychloroquine was used in 95% of SLE patients and steroid therapy was used in 93% in which 60.95% received Methylprednisolone pulse. The immunosuppressive agent of choice was Cyclophosphamide in 25.04%. Mycophenolic acid (MPA) medication in 39.85% and azathioprine in 37.06% of patients. Anti CD20 monoclonal antibodies, rituximab, was used in 20.91%. Calcineurin inhibitors were used in total of 11% of patients (cyclosporin a in 6.72% and tacrolimus in 4.35%). Conclusion: The complexity of SLE presentation have led to diverse pharmacotherapeutic strategies based on the organ systems involved. Management is individualized and depends on presenting symptoms and reducing the likelihood of permanent damage to organs and tissues. Strengthen health system at primary level and education of public and health work force is the main challenge to further improve the management. The overall aim of management was to determine the extent of disease and prevent extensive organ involvement and deal with various traditional and non-traditional CVD risk factors. The involvement of clinical pharmacist is very important to further strengthen the pharmacological management of lupus patients.