Murray B Urowitz1, Dafna D Gladman2, Dominique Ibañez2, Jiandong Su2, Sara Mursleen3, Amyn Sayani3, Jorge Alfonso Ross Terres3,4, Sandra Iczkovitz3. 1. M.B. Urowitz, MD, D.D. Gladman, MD, D. Ibañez, MSc, J. Su, MSc, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada; m.urowitz@utoronto.ca. 2. M.B. Urowitz, MD, D.D. Gladman, MD, D. Ibañez, MSc, J. Su, MSc, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada. 3. S. Mursleen, MSc, A. Sayani, PhD, S. Iczkovitz, MSc, GlaxoSmithKline Inc., Toronto, Ontario, Canada. 4. J.A.R. Terres, MD, GlaxoSmithKline Inc., Toronto, Ontario, Canada, and GlaxoSmithKline Inc., Philadelphia, Pennsylvania, USA.
Abstract
OBJECTIVE: To examine the role of disease activity on organ damage over 5 years in patients with active systemic lupus erythematosus (SLE) despite standard of care. METHODS: This analysis of the University of Toronto Lupus Clinic cohort assessed organ damage [measured by Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)] in patients with active SLE [SLE Disease Activity Index 2000 (SLEDAI-2K) ≥ 6], using Cox proportional time-independent hazard models. Subgroup analyses were conducted in patients with SLEDAI-2K 6 or 7, 8 or 9, and ≥ 10 at baseline, and in the overall study population by steroid dose at study entry (< 7.5 vs ≥ 7.5 mg/day). RESULTS: Among the overall study population (n = 649), SDI progression was observed in 209 (32.2%) patients over the 5-year follow-up period. Mean SDI change in patients with a score > 0 was generally consistent across all SLEDAI-2K subgroups. Multivariable analyses identified age at study start (HR 1.03, P < 0.0001), steroid dose (HR 2.03, P < 0.0001), immunosuppressants (HR 1.44, P = 0.021), and SLEDAI-2K (subgroup analyses HR 1.64-2.03, P = 0.0017 to < 0.0001) as the greatest risk factors for SDI progression, while a study start date after the year 2000 had a protective effect on SDI progression compared with a start date prior to the year 2000 (HR 0.65, P = 0.0004). CONCLUSION: Patients within the higher SLEDAI-2K subgroups at study entry or receiving high doses of steroids were more likely to have organ damage progression.
OBJECTIVE: To examine the role of disease activity on organ damage over 5 years in patients with active systemic lupus erythematosus (SLE) despite standard of care. METHODS: This analysis of the University of Toronto Lupus Clinic cohort assessed organ damage [measured by Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)] in patients with active SLE [SLE Disease Activity Index 2000 (SLEDAI-2K) ≥ 6], using Cox proportional time-independent hazard models. Subgroup analyses were conducted in patients with SLEDAI-2K 6 or 7, 8 or 9, and ≥ 10 at baseline, and in the overall study population by steroid dose at study entry (< 7.5 vs ≥ 7.5 mg/day). RESULTS: Among the overall study population (n = 649), SDI progression was observed in 209 (32.2%) patients over the 5-year follow-up period. Mean SDI change in patients with a score > 0 was generally consistent across all SLEDAI-2K subgroups. Multivariable analyses identified age at study start (HR 1.03, P < 0.0001), steroid dose (HR 2.03, P < 0.0001), immunosuppressants (HR 1.44, P = 0.021), and SLEDAI-2K (subgroup analyses HR 1.64-2.03, P = 0.0017 to < 0.0001) as the greatest risk factors for SDI progression, while a study start date after the year 2000 had a protective effect on SDI progression compared with a start date prior to the year 2000 (HR 0.65, P = 0.0004). CONCLUSION:Patients within the higher SLEDAI-2K subgroups at study entry or receiving high doses of steroids were more likely to have organ damage progression.
Authors: Manuel Francisco Ugarte-Gil; Anselm Mak; Joanna Leong; Bhushan Dharmadhikari; Nien Yee Kow; Cristina Reátegui-Sokolova; Claudia Elera-Fitzcarrald; Cinthia Aranow; Laurent Arnaud; Anca D Askanase; Sang-Cheol Bae; Sasha Bernatsky; Ian N Bruce; Jill Buyon; Nathalie Costedoat-Chalumeau; Mary Ann Dooley; Paul R Fortin; Ellen M Ginzler; Dafna D Gladman; John Hanly; Murat Inanc; David Isenberg; Soren Jacobsen; Judith A James; Andreas Jönsen; Kenneth Kalunian; Diane L Kamen; Sung Sam Lim; Eric Morand; Marta Mosca; Christine Peschken; Bernardo A Pons-Estel; Anisur Rahman; Rosalind Ramsey-Goldman; John Reynolds; Juanita Romero-Diaz; Guillermo Ruiz-Irastorza; Jorge Sánchez-Guerrero; Elisabet Svenungsson; Murray Urowitz; Evelyne Vinet; Ronald F van Vollenhoven; Alexandre Voskuyl; Daniel J Wallace; Michelle A Petri; Susan Manzi; Ann Elaine Clarke; Mike Cheung; Vernon Farewell; Graciela S Alarcon Journal: Lupus Sci Med Date: 2021-12
Authors: Roger A Levy; Tania Gonzalez-Rivera; Munther Khamashta; Norma Lynn Fox; Angela Jones-Leone; Bernie Rubin; Susan W Burriss; Kerry Gairy; Andre van Maurik; David A Roth Journal: Lupus Date: 2021-07-08 Impact factor: 2.911