Different Risk Profiles for Development of Steroid-Related and Steroid-Unrelated Damage in Early Diagnosed SLE: Results from the Italian Multicenter Early Lupus Project Inception Cohort

Matteo Piga¹, Gian Domenico Sebastiani², Imma Prevete³, Florenzo Iannone⁴, Laura Coladonato⁵, Marcello Govoni⁶, Alessandra Bortoluzzi⁷, Marta Mosca⁸, Chiara Tani⁸, Andrea Doria⁹, Luca Iaccarino¹⁰, Angela Tincani¹¹, Micaela Fredi¹², Fabrizio Conti¹³, Francesca Spinelli¹⁴, Mauro Galeazzi¹⁵, Francesca Bellisai¹⁶, Anna Zanetti¹⁷, Greta Carrara¹⁸, Carlo Alberto Scirè¹⁹ and Alessandro Mathieu¹, ¹Unit and Chair of Rheumatology, University Hospital of Cagliari, Cagliari, Italy, ²Rheumatology, San Camillo Forlanini Hospital, Roma, Italy, ³Azienda Ospedaliera San Camillo of Rome, Roma, Italy, ⁴Reumatologia Universita e Policlinico di Bari, Bari, Italy, ⁵Reumatologia, Università e Policlinico di Bari, Bari, Italy, ⁶UOC of Rheumatology, University Hospital S. Anna, Cona Ferrara, Italy, ⁷Section of Rheumatology, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-University Hospital S. Anna, Cona Ferrara, Italy, ⁸Rheumatology Unit, University of Pisa, Pisa, Italy, ⁹University and Azienda Ospedaliera of Padova, Padova, Italy, ¹⁰Department of Medicine-DIMED, University of Padova, Padova, Italy, ¹¹Department of Clinical and Experimental Sciences, Spedali Civili and University of Brescia, Brescia, Italy, Rheumatology and Clinical Immunology, BRESCIA, Italy, ¹²Department of Clinical and Experimental Sciences, Spedali Civili and University of Brescia, Brescia, Italy, Rheumatology and Clinical Immunology, Brescia, Italy, ¹³Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy, ¹⁴Dipartimento di Medicina Interna e Specialita` Mediche, Sapienza Universita` di Roma, Roma, Italy, ¹⁵Rheumatology, University Hospital of Siena, Siena, Italy, ¹⁶UOC di Reumatologia, Azienda Ospedaliera Universitaria Senese, Siena, Italy, ¹⁷Italian Society for Rheumatology, Milano, Italy, ¹⁸Epidemiology Unit, Italian Society for Rheumatology, Milano, Italy, ¹⁹Italian Society for Rheumatology, Milan, Italy

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: diagnosis, outcomes, steroids and systemic lupus erythematosus (SLE)

Session Information

Date: Tuesday, October 23, 2018

Title: Systemic Lupus Erythematosus – Clinical Poster III: Treatment

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:

Preventing organ damage is a major challenge in Systemic Lupus Erythematosus (SLE).To evaluate factors associated with development of steroid-related and unrelated damage in an inception cohort of early diagnosed SLE patients.

Methods:

The Early Lupus Project encompasses 9 Italian centers recruiting consecutive patients diagnosed within 12 months of SLE (1). At enrolment and then every 6 months a panel of data (including demographic, comorbidities, serologic, clinic by BILAG2004 domains, ECLAM, HRQoL by visual analogic scale and treatment) was recorded.

Using univariate analysis, we assessed the contribution of covariates collected at baseline in development of steroid-related and not-related damage categorized according to previous definition (2) and assessed by the SLICC/ACR Damage Index (SDI from 0 to ≥1). Forward-Backward Cox-regression models were fitted with covariates with p<0.05 to identify factors independently associated with increased risk of damage development.

Results:

Overall, 279 patients were enrolled in the Early Lupus Project inception cohort up to the 31th of December 2017; 230 patients (89.6% Caucasians, 13.4% males) were eligible for this study having SDI=0 at enrolment and at least 6 months of follow-up. Age (mean ± SD) at diagnosis was 36.5 ± 14.4 years, the median interval between diagnosis and recruitment was 1.1 months (interquartile range 0.0-4.8) and median follow-up was 27.4 months (interquartile range 7.2-48.0).

At last follow-up visit 84 patients (36.5%) had an SDI score ≥1 (median = 0; interquartile range 0-1); 38 of them (16.5%) developed steroid-related damage and 58 (25.2%) developed steroid-unrelated damage. Figure A shows the kinetics of damage development.

Factors independently associated with increased risk of developing steroid-related damage were baseline neuropsychiatric involvement (p<0.001; HR 5.0 95% CI 2.3-10.6), older age (p=0.001; HR 3.9 95%CI 1.8- 8.7) and cumulative prednisone dose (p<0.001; HR 3.1 per 10 grams; 95%CI 1.6-5.7) were (Figure B). Factors independently associated with increased risk of steroid-unrelated damage accrual were baseline dyslipidemia (p<0.001; HR 3.9 95% CI 2.1-7.1), cardiorespiratory involvement (p<0.001; HR 3.3 95% CI 1.9-5.9), and cumulative prednisone dose (p<0.001; HR 1.0001 per 10 grams; 95%CI 2.1-3.4),whereas hydroxychloroquine reduced the risk of steroid-unrelated damage (p=0.041; HR 0.53; 95%CI 0.29-0.98) (Figure C).

Conclusion:

The risk profile for damage development in this early SLE cohort differs for steroid-related and unrelated damage. Addressing modifiable risk factors, adding hydroxychloroquine since the very early stages and treating disease activity to target remission or minimal disease activity, may reduce damage and improve patients outcome.

1. Sebastiani GD, et al. Lupus. 2015;24:1276-82.

2. Gladman D, et al. J Rheumatol 2003;30;1955-1959

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Disclosure: M. Piga, None; G. D. Sebastiani, None; I. Prevete, None; F. Iannone, None; L. Coladonato, None; M. Govoni, None; A. Bortoluzzi, None; M. Mosca, None; C. Tani, None; A. Doria, None; L. Iaccarino, GSK, 5; A. Tincani, Bristol-Myers Squibb, 2,UCB, Inc., 5; M. Fredi, None; F. Conti, None; F. Spinelli, None; M. Galeazzi, None; F. Bellisai, None; A. Zanetti, None; G. Carrara, None; C. A. Scirè, None; A. Mathieu, None.

To cite this abstract in AMA style:

Piga M, Sebastiani GD, Prevete I, Iannone F, Coladonato L, Govoni M, Bortoluzzi A, Mosca M, Tani C, Doria A, Iaccarino L, Tincani A, Fredi M, Conti F, Spinelli F, Galeazzi M, Bellisai F, Zanetti A, Carrara G, Scirè CA, Mathieu A. Different Risk Profiles for Development of Steroid-Related and Steroid-Unrelated Damage in Early Diagnosed SLE: Results from the Italian Multicenter Early Lupus Project Inception Cohort [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/different-risk-profiles-for-development-of-steroid-related-and-steroid-unrelated-damage-in-early-diagnosed-sle-results-from-the-italian-multicenter-early-lupus-project-inception-cohort/. Accessed .

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