Date: Sunday, November 7, 2021
Session Type: Poster Session B
Session Time: 8:30AM-10:30AM
Background/Purpose: Cognitive dysfunction (CD) is a common manifestation of systemic lupus erythematosus (SLE) which can have detrimental consequences for those affected. To date, no treatments have been approved for SLE-associated CD (SLE-CD). This study aims to assess the association of azathioprine (AZA) and mycophenolate (MMF) use with SLE-CD, given that these medications have demonstrated neuroprotective qualities in prior studies.
Methods: Consecutive adult SLE patients presenting to a single center were screened. The American College of Rheumatology (ACR) neuropsychological battery (NB) for SLE, evaluating 6 cognitive domains, was administered to consenting participants at 0, 6 and 12 months. Age and gender matched normative data were used to obtain z-scores. CD was determined by a z-score of £-1.5 in ³2 cognitive domains. Non-CD was defined as no z-score £-1.5. MMF and AZA use were recorded as cumulative dose (grams per kilogram [g/kg]), duration of treatment (number of years) and current use for ³6 months from visit day. Clinical and demographic characteristics were verified at each visit. Baseline characteristics by cognitive status and medication use were documented. Mixed-effects logistic regression models were constructed to estimate the odds of CD and non-CD with respect to AZA and MMF use over the three follow-up periods.
Results: Three hundred participants representing 676 patient visits completed the study; 157 (52%) met criteria for CD at baseline. Mean age was 41.1 years (SD 12.1) and 267 participants (89.0%) were female. Table 1 outlines baseline characteristics by CD and non-CD status. There were no significant differences in mean age, glucocorticoid dose, disease duration, SLE Disease Activity Index-2000 (SLEDAI-2K) scores, or SLICC-ACR Damage Index (SDI) scores. In contrast, there were significantly more participants with CD who identified as Black or Chinese, and significantly fewer participants identifying as White. There were also fewer married participants with CD. Table 2 documents baseline characteristics by AZA and MMF use with respect to CD status. Participants taking AZA or MMF had significantly higher SLEDAI-2K scores and higher prevalence of nephritis; participants taking MMF had higher rates of hypertension, higher daily doses of glucocorticoid medications and lower rates of smoking.
Table 3 shows results of the mixed effects models for AZA and MMF use versus CD. For each g/kg of cumulative AZA, there was on average a 24% reduced odds of CD: OR 0.76, 95% CI 0.61, 0.96, p=0.02. For each year of AZA treatment there was on average a 32% reduced odds of CD: OR 0.68 (0.50, 0.94), p=0.02. AZA use as binary variable (yes versus no) demonstrated a consistent trend toward reduced odds of CD with AZA use without reaching statistical significance: OR 0.29 (0.08, 1.12), p=0.07. Cumulative AZA dose was not significantly associated with non-CD status: 1.08 (0.91, 1.27), p=0.38 (not shown). MMF use was not associated with CD or non-CD.
Conclusion: Despite higher disease activity scores in participants taking AZA compared to those not taking AZA, cumulative AZA dose and increasing AZA treatment duration were associated with significantly lower odds of SLE-CD. MMF use was not associated with SLE-CD.
To cite this abstract in AMA style:Dobrowolski C, Su J, McGinley J, Fazzari M, Bingham K, Anderson N, Beaton D, Ruttan L, Wither J, Tartaglia M, Kakvan M, Bonilla D, Choi M, Fritzler M, Katz P, Green R, Putterman C, Touma Z. Association of Mycophenolate and Azathioprine Use with Cognitive Function in SLE [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 10). https://acrabstracts.org/abstract/association-of-mycophenolate-and-azathioprine-use-with-cognitive-function-in-sle/. Accessed January 24, 2022.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-of-mycophenolate-and-azathioprine-use-with-cognitive-function-in-sle/