Background/Purpose: Patients with systemic lupus erythematosus (SLE) suffer an impaired health-related quality of life (HRQoL), and the majority of them experience fatigue as a major problem. Traditionally, treatment of SLE has been symptomatic, and antimalarial agents (AMA) are considered a cornerstone of SLE treatment. In previous literature, results regarding the effect of antimalarial agents on HRQoL have been conflicting. In this study, we aimed at investigating the potential influence of AMA on SLE patients’ self-perception of HRQoL aspects.

Methods: We utilised pooled baseline data from the BLISS-52 and BLISS-76 clinical trials of belimumab (n=1684). Access to data was granted by GlaxoSmithKline. The patients’ HRQoL and fatigue were self-reported using the Medical Outcomes Study (MOS) short form 36 (SF-36) health survey, the functional assessment of chronic illness therapy (FACIT)-Fatigue scale and the three-level EuroQol-5 Dimension (EQ-5D) questionnaire. Minimal clinically important difference (MCID) was set to ≥5.0 points for SF-36 subscales, ≥2.5 points for SF-36 component summary scores, and ≥4 points for FACIT-Fatigue scores. High disease activity was defined as a SELENA-SLEDAI score ≥10. Organ damage was assessed using the SLICC/ACR Damage Index (SDI). The non-parametric Mann-Whitney U test was used for comparisons between AMA users and non-users. Linear regression models were next used in order to adjust for possible confounding factors; these included age, sex, ethnic origin, SLE disease activity, SLE duration, organ damage, corticosteroid use and use of other immunosuppressive agents.

Results: Results are presented as mean values ± standard devation. Patients receiving AMA (n=1098) performed better than patients who did not receive AMA (n=586) with regard to SF-36 physical component summary (PCS) scores (39.6 ± 9.5 versus 38.1 ± 9.9; P=0.001), physical functioning (61.1 ± 24.9 versus 55.0 ± 26.5; P< 0.001), role physical (53.2 ± 26.9 versus 50.3 ± 27.7; P=0.036), bodily pain (49.5 ± 23.8 versus 47.1 ± 25.3; P=0.016), FACIT-Fatigue scores (30.5 ± 11.8 versus 29.3 ± 11.9; P=0.046), EQ-5D scores (0.75 ± 0.18 versus 0.72 ± 0.19; P=0.004) and EQ-5D visual analogue scale (VAS) scores (64.6 ± 19.4 versus 61.7 ± 18.6; P=0.001). The difference in SF-36 physical functioning was the greatest among the SF-36 parameters, exceeding the corresponding MCID (≥5.0 points). The association between AMA use and better physical functioning was still significant after adjustment for confounding factors (standardised coefficient, β =0.08; P=0.001). In this analysis, Asian patients performed better in physical functioning ( β =0.07; P=0.004) while African/African American patients performed worse ( β =-0.07; P=0.003). High disease activity ( β =-0.09; P< 0.001) and organ damage ( β =-0.12; P< 0.001) were also independent factors of worse physical functioning, whereas corticosteroid use independently improved the outcome ( β =0.06; P=0.022).

Conclusion: In the SLE populations of the BLISS-52 and BLISS-76 clinical trials, AMA use was associated with favourable HRQoL in terms of physical functioning independently of other factors.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/antimalarial-agents-improve-physical-functioning-in-patients-with-systemic-lupus-erythematosus/