Session Information
Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment: Treatment and Management Studies
Session Type: Abstract Submissions (ACR)
Background/Purpose: The treatment algorithm for patients with new onset systemic lupus erythematosus (SLE) is more variable than that for other rheumatic diseases (e.g. rheumatoid arthritis). We examined the treatment patterns, with a particular emphasis on corticosteroids (CS), in an inception cohort of SLE patients over the first 3 years of disease.
Methods: The study was conducted at a single academic center with a longitudinal lupus database. All patients fulfilled the ACR classification criteria for SLE within 12 months preceding their enrollment and completed at least 3 subsequent annual followup visits during which data since the previous assessment were recorded. Information was collected per protocol at each visit and included patient demographics, SLE manifestations, medications, SLE disease activity index-2K (SLEDAI-2K), SLICC/ACR damage index (SDI) and SF-36 for assessment of health related quality of life (HRQoL). Analysis included descriptive statistics and repeated measures mixed models.
Results: Seventy-nine patients, 86.1% female and 91.1% Caucasian were studied. At baseline the mean ± SD age was 39.8 ± 16.1 years, disease duration was 0.36 ± 0.28 years and SLEDAI-2K was 5.7 ± 4.6. Over 3 years the cumulative exposure to CS, antimalarials (AM) and immunosuppressive (IM) drugs was 53.2%, 77.2% and 40.5% respectively, and CS were virtually always used in combination with AM and/or IM. The use of CS fell between baseline and final assessments (44.3% vs. 15.2%) in contrast to the use of AM (55.7% vs. 70.9%) and IM (26.6% vs. 24.2%). Of the 44/79 (55.7%) patients who were not receiving CS at baseline 84.1% remained off CS for the duration of the study. Thirty-seven of 79 (46.8%) patients never received CS and only 5/79 (6.3%) of patients were taking corticosteroids at all 4 assessments. Patients exposed to CS at baseline had higher mean ± SD daily dose and cumulative dose of CS over 3 years compared to patients not on CS at baseline (9.0 ± 6.8 vs. 0.3 ± 1.3 mg; 10.8 ± 8.5 vs. 0.3 ± 1.2 gr.) The adjusted mean SLEDAI-2K over 3 years was higher in patients exposed to CS regardless of whether group assignment was determined by cumulative dose (none vs > 10 g: 2.7 ± 1.9 vs 6.5 ± 3.5; p=0.0001), CS at baseline visit (none vs present: 2.9 ± 2.1 vs 5.1 ± 3.9; p=0.006) or CS exposure at any time during the study (2.7 ± 1.9 vs 3.8 ± 0.6; p=0.002).Using the same group assignments CS exposure over 3 years was associated with a significant fall in SLEDAI-2K scores (p<0.05) compared to patients not exposed to CS. There was no consistent association with baseline SDI or HRQoL or change over time.
Conclusion: Exposure to CS occured in approximately half of the patients with new onset SLE, usually in association with AM and/or IM. It was associated with both higher disease activity, especially at baseline, and a subsequent fall in disease activity over time. In SLE patients who do not receive CS at disease presentation, the introduction of CS is very unlikely over the next 3 years.
Disclosure:
J. G. Hanly,
None;
A. Sayani,
GlaxoSmithKline,
3;
S. Doucette,
None;
S. Iczkovitz,
GlaxoSmithKline,
3;
J. A. Ross,
GlaxoSmithKline,
3.
« Back to 2014 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/corticosteroids-in-early-treatment-pathways-in-sle/