Yoosuf Ali Ashraf Muhammad Hussenbocus1, Ziyi Jin2, Wenyou Pan3, Lin Liu4, Min Wu5, Huaixia Hu6, Xiang Ding7, Hua Wei8, Yaohong Zou9, Xian Qian10, Meimei Wang11, Jian Wu12, Juan Tao13, Jun Tan14, Zhanyun Da15, Miaojia Zhang16, Jing Li17, Xuebing Feng18, Lingyun Sun19,20. 1. Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China. 2. Department of Rheumatology and Immunology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China. jzy-327@163.com. 3. Department of Rheumatology, Huai'an First People's Hospital, Huai'an, China. 4. Department of Rheumatology, Xuzhou Central Hospital, Xuzhou, China. 5. Department of Rheumatology, the Third Affiliated Hospital of Soochow University, Changzhou, China. 6. Department of Rheumatology, Lianyungang Second People's Hospital, Lianyungang, China. 7. Department of Rheumatology, Lianyungang First People's Hospital, Lianyungang, China. 8. Department of Rheumatology, Northern Jiangsu People's Hospital, Yangzhou, China. 9. Department of Rheumatology, Wuxi People's Hospital, Wuxi, China. 10. Department of Rheumatology, Jiangsu Province Hospital of TCM, Nanjing, China. 11. Department of Rheumatology, Southeast University Zhongda Hospital, Nanjing, China. 12. Department of Rheumatology, the First Affiliated Hospital of Soochow University, Suzhou, China. 13. Department of Rheumatology, Wuxi TCM Hospital, Wuxi, China. 14. Department of Rheumatology, Zhenjiang First People's Hospital, Zhenjiang, China. 15. Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, China. 16. Department of Rheumatology, Jiangsu Province Hospital, Nanjing, China. 17. Department of Rheumatology, Affiliated Hospital of Jiangsu University, Jiangsu, China. 18. Department of Rheumatology and Immunology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China. 19. Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China. lingyunsun@nju.edu.cn. 20. Department of Rheumatology and Immunology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China. lingyunsun@nju.edu.cn.
Abstract
OBJECTIVE: To investigate the effect of cyclophosphamide (CYC) on organ involvement and SLE patients' overall and cause-specific mortality. METHODS: Information about CYC prescription was taken from the Jiangsu Lupus database, which was set up to collect medical records from SLE patients since their first admission during 1999-2009 in Jiangsu province, China. Follow-up studies were carried out in 2010 and 2015 to check the survival status of the patients. Cox regression models were used to estimate the hazard ratio (HR) and 95% CI. Kaplan-Meier model was used to assess the effect of CYC on mortality between organ involvement and non-involvement. RESULTS: There were 221 deaths observed out of 2446 SLE patients. CYC users decreased overall mortality of SLE (8.4%) with adjusted HR (95% CI) of 0.74 (0.56-0.97), as compared to non-users. A decrease in overall mortality of SLE was found in the low dosage (< 600 mg) of CYC users, with adjusted HR (95% CI) of 0.54 (0.36-0.81). The protection of CYC on mortality of SLE was further observed in subgroups, such as female; SLEDAI score ≥ 15 group; and those with neuropsychiatric, renal, and hematological involvements, and low serum C3. In addition, CYC could eliminate the differences in mortality between organ involvement and non-involvement, including renal, neuropsychiatric, cardiopulmonary, gastrointestinal, and hematological involvement, but not for mucocutaneous and musculoskeletal involvement. CONCLUSION: Low dosage use of CYC decreased the risk of overall mortality of SLE. CYC might improve the survival of SLE patients with renal, neuropsychiatric, cardiopulmonary, gastrointestinal, and hematological involvements. Key Points • Cyclophosphamide decreases overall mortality of SLE patients. • Decreased mortality is mainly observed from low dosage use of cyclophosphamide. • Cyclophosphamide improves the survival of SLE patients when major systems such as renal, neuropsychiatric, cardiopulmonary, gastrointestinal, and hematological are involved.
OBJECTIVE: To investigate the effect of cyclophosphamide (CYC) on organ involvement and SLE patients' overall and cause-specific mortality. METHODS: Information about CYC prescription was taken from the Jiangsu Lupus database, which was set up to collect medical records from SLE patients since their first admission during 1999-2009 in Jiangsu province, China. Follow-up studies were carried out in 2010 and 2015 to check the survival status of the patients. Cox regression models were used to estimate the hazard ratio (HR) and 95% CI. Kaplan-Meier model was used to assess the effect of CYC on mortality between organ involvement and non-involvement. RESULTS: There were 221 deaths observed out of 2446 SLE patients. CYC users decreased overall mortality of SLE (8.4%) with adjusted HR (95% CI) of 0.74 (0.56-0.97), as compared to non-users. A decrease in overall mortality of SLE was found in the low dosage (< 600 mg) of CYC users, with adjusted HR (95% CI) of 0.54 (0.36-0.81). The protection of CYC on mortality of SLE was further observed in subgroups, such as female; SLEDAI score ≥ 15 group; and those with neuropsychiatric, renal, and hematological involvements, and low serum C3. In addition, CYC could eliminate the differences in mortality between organ involvement and non-involvement, including renal, neuropsychiatric, cardiopulmonary, gastrointestinal, and hematological involvement, but not for mucocutaneous and musculoskeletal involvement. CONCLUSION: Low dosage use of CYC decreased the risk of overall mortality of SLE. CYC might improve the survival of SLE patients with renal, neuropsychiatric, cardiopulmonary, gastrointestinal, and hematological involvements. Key Points • Cyclophosphamide decreases overall mortality of SLE patients. • Decreased mortality is mainly observed from low dosage use of cyclophosphamide. • Cyclophosphamide improves the survival of SLE patients when major systems such as renal, neuropsychiatric, cardiopulmonary, gastrointestinal, and hematological are involved.
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