<h3>Background:</h3> Glucocorticoids (GC) are commonly used in the management of systemic lupus erythematous (SLE). However, there are marked differences in GC use globally and this variation may be attributed to differences in clinical practices, regional preferences, local guidelines and a lack of consensus of standardised international recommendations. The global patterns of GC use and factors influencing these diverse practices are currently poorly understood. <h3>Objectives:</h3> We sought to evaluate the variations in GC use in the management of SLE globally and factors associated with patterns of GC therapy. Additionally, we aimed to identify factors associated with GC use based on patient demographics, disease activity, Human Development Index (HDI) and concomitant DMARDs use. <h3>Methods:</h3> Data for patients with SLE from more than 80 countries was extracted from the COVAD-2 database. Individuals were grouped into regions based on geographical location. A logistic regression model was constructed to identify associations between region and GC use. Multivariate adjustment was made for age, gender, health status, hydroxychloroquine (HCQ) use and HDI (a composite index formulated by the United Nations to rank countries into tiers of development). Odds ratios (OR) were recorded with corresponding 95% confidence intervals (CI). To explore regional differences, mean steroid use by region was mapped globally. Regions with fewer than five patients were excluded from mapping. <h3>Results:</h3> A total of 1292 SLE patients were included in the study. The majority of patients were from Asia (35.9%) and Europe (27.2%) with 94.9% being female. Median age was 40 years with a median disease duration of 8 years. Full patient demographics are summarised in Table 1. More than half of the patients (54.6%) were on GC with 13.2% being on high dose (defined as ≥20 mg Prednisolone equivalent/ day). Patients on GC were younger than those not on GC (median 38 years, IQR 30-48 vs 43 years, IQR 31-50, p <0.001) and were younger at age of diagnosis of SLE (median 26 years, IQR 20-34 vs 29 years, IQR 22-39, p<0.001). On a regional level, GC use was highest in Asia (64.4%) compared to South America (58.9%), Africa (58.6%), North America (48.3%) and Europe (41.5%). HCQ use was associated with reduced risk of being on GC [all GC unadjusted OR 0.65 (95% CI 0.51 - 0.83) showing the potential steroid sparing capacity of HCQ. Regional variability of GC use is summarised in Figure 1A, which shows low frequency of GC use noted in North Africa compared with high levels of GC use in sub-Saharan Africa. In the logistic regression model, region associated with GC use. Compared with Europe, patients in Asia, Africa and South America were more likely to use GC, with the highest odds of GC use seen in Central Africa and South Asia (OR 7.09 and 5.24, respectively). (Figure 1B). <h3>Conclusion:</h3> We identified substantial regional variations in GC use in the management of SLE globally. HCQ use associated with a reduced risk of GC exposure, indicating potential steroid-sparing effect. We demonstrate ongoing regional variability in GC use after controlling for patient demographics, HCQ use and HDI. It is possible there are additional factors influencing GC prescribing, such as prevalence, severity and phenotype of disease, which we have not been able to adjust for. Regional variation may reflect differences in availability, accessibility and affordability of other treatments including DMARDs and biologic therapies This variation may also represent variation in clinical guidelines, practices, and patient/physician preferences and beliefs in treatment of the disease. The study highlighted the need for more research and education on the optimal use of steroids in SLE patients internationally. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Gagandeep Sukhija: None declared, Eman Elfar: None declared, Amelia Holloway: None declared, Katie Bechman: None declared, Sreoshy Saha: None declared, Tsvetelina Velikova: None declared, Elena Nikiphorou: None declared, Esha Kadam: None declared, Carlos Enrique Toro-Gutierrez: None declared, Rohit Aggarwal Bristol Myers-Squibb, Pfizer, Genentech, Octapharma, CSL Behring, Mallinckrodt, AstraZeneca, Corbus, Kezar, Abbvie, Janssen, Kyverna Alexion, Argenx, Q32, EMD-Serono, Boehringer Ingelheim, Roivant, Merck, Galapagos, Actigraph, Scipher, Horizon Therepeutics, Teva, Beigene, ANI Pharmaceuticals, Biogen, Nuvig, Capella Bioscience, and CabalettaBio., Vikas Agarwal: None declared, Latika Gupta: None declared, Chris Wincup: None declared.
