Steroids mask true needs: How delayed escalation derails Lupus launches before they begin

The stability trap at the heart of lupus launches 

Corticosteroids are often the first-line treatment in Lupus -  familiar, fast-acting, and effective at suppressing symptoms. But that apparent stability creates one of the most costly misconceptions in early launch planning. 

Steroids mask ongoing disease activity, delay escalation, and lull both physicians and patients into a false sense of control. In this window - between diagnosis and long-term treatment planning - patients begin to silently disengage. And the brand loses the opportunity to build early momentum. 

This trap doesn’t unfold in clinical data alone. It plays out commercially - in missed prescriptions, stagnant field productivity, and market share that never materializes. 

Drop-off doesn’t start at non-adherence, it starts with escalation delay

Commercial teams are well aware that the patient journey begins long before the first prescription. But in Lupus, there is a distinct gap that often goes unaddressed: the phase between diagnosis and escalation. This is where many patients are placed on corticosteroids, experience short-term relief, and - without structured guidance - quietly exit the care pathway. 

This isn’t non-adherence. It’s a missed moment for orientation and activation. And for brand teams, it’s one of the costliest phases to overlook. 

Patient support programs are critical - but they arrive too late to catch early drop-off

Patient Support Programs remain a cornerstone of most launch architectures. But they are typically designed to engage patients after treatment decisions have been made. In Lupus, this means they often activate too late - after escalation momentum has already been lost.

The patients most at risk are not those who decline support. They are the ones who never reach the point where support is offered. They stall early. They feel reassured by symptom relief. And without engagement infrastructure in place during the post-diagnosis, pre-prescription window, they quietly drop off - before a brand ever enters the conversation. 

Temedica internal analysis of real-world Lupus journeys indicates that up to 43% of patients disengage before a PSP is ever offered¹. In fact, these aren’t rare edge cases - they’re a primary reason why many launches underdeliver in their first year.

Why activation is so fragile in Lupus 

Lupus is one of the most behaviorally fragile therapeutic areas. Its symptoms are often invisible. The emotional burden is high. And diagnosis is frequently delayed or miscommunicated. By the time a patient receives a label and their first therapy - often corticosteroids - they are emotionally fatigued, uncertain, and disoriented. 

Without proactive support, clear next steps, or a reason to stay engaged, these patients don’t resist treatment - they quietly disappear. Longitudinal data shows that loss to follow-up is especially prevalent in Lupus, and often occurs without formal discontinuation². 

The real problem isn’t patient resistance. It’s the absence of friction at the wrong time - no check-in, no escalation signal, no prompt to re-engage. 

Field force alone can't intervene in time

Even the most sophisticated field strategies can't intercept disengagement that happens days or weeks after diagnosis. By the time the representative has reached the HCP, the patient has often returned home with steroids - and a belief that the situation is under control. 

Clearly, the effectiveness of the field force isn’t the issue. It’s a structural blind spot. The real challenge is timing - and building engagement logic for the post-diagnosis, pre-prescription window, when patients are most uncertain and the system is most quiet.

Escalation is not just a clinical decision - it’s a commercial lever

In specialty care, therapy escalation isn’t guaranteed. And in Lupus, it’s frequently delayed. Even in centers of excellence, patients often remain on antimalarials or steroids for extended periods, with no movement toward advanced therapies. 

What seems like a clinical delay is often a missed commercial window. Brands that fail to prompt escalation early lose market momentum - and with it, long-term positioning.

Unless escalation logic is hardwired into the launch infrastructure with timely detection, engagement triggers, and patient-level activation, drop-off sets in before the brand ever gains traction.

The commercial cost of the corticosteroid trap 

The result? Missed prescriptions, stagnant field force productivity, delayed payer traction, and long-term underperformance. 

What leading launch teams are doing differently 

Top-performing Lupus launch teams are not waiting for prescription to begin engagement. They are investing in: 

• Educational touchpoints immediately post-diagnosis 

• Signal-based logic that identifies when patients are stuck on steroids 

• Segmented activation journeys based on behavior, not just treatment line 

• Coordinated clinical and digital engagement - designed to make escalation part of the journey, not an exception 

These teams aren’t overhauling their Patient Support Programs or sidelining their field force. They’re ensuring both are supported by systems that activate early, catch friction fast, and personalize engagement before momentum is lost. 

Strategic takeaway 

The most consequential drop-off in a Lupus launch doesn’t happen after prescription. It happens in silence - after steroids, before escalation, before support. And if your launch plan doesn’t account for that phase, the first 18 months will underperform, regardless of brand equity or access. 

The challenge is not awareness. It’s timing.

The signal is not resistance. It’s inactivity. 

If you're waiting for the prescription to begin engagement, you've already missed the moment that matters. 

Temedica partners with pharma teams to build scalable engagement systems tailored to high-friction markets like Lupus, designed to identify drop-off early, support escalation, and activate patients before silence sets in. 

👉 Book a strategic session with our Lupus go-to-market experts

References:

[1] Temedica internal source: Lupus patient journey engagement analysis, 2024.

[2] Lupus cohort analysis: factors associated with being lost to follow-up. Lupus. 2006;15(1):19–25. 

[3] Clinical review of corticosteroid overuse and its impact on escalation timing. J Clin Med. 2023;12(11):3639. 

[4] Launch performance benchmarks and early market share capture. IQVIA Launch Excellence VIII, 2022.