Disease Activity Is an Independent Predictor of Leukopenia in a Large International SLE Cohort

Rangi Kandane-Rathnayake¹, Vera Golder², Worawit Louthrenoo³, Sargunan Sockalingam⁴, Aisha Lateef⁵, Yuan An⁶, Leonid Zamora⁷, Yeong-Jian Wu⁸, Shue-Fen Luo⁹, Madelynn Chan¹⁰, Fiona Goldblatt¹¹, Chak Sing Lau¹², Zhan-Guo Li¹³, Sandra V. Navarra⁷, Mandana Nikpour¹⁴, Eric F Morand¹⁵ and Alberta Y. Hoi², ¹Rheumatology, Monash University, Melbourne, Australia, ²Centre for Inflammatory Diseases, Monash University, Melbourne, Australia, ³Division of Rheumatology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand, ⁴University of Malaya, Kuala Lumpur, Malaysia, ⁵Medicine, Division of Rheumatology, National University Hospital of Singapore, Singapore, Singapore, ⁶Peking University People's Hospital, Beijing, China, ⁷Rheumatology, University of Santo Tomas Hospital, Manila, Philippines, ⁸Chang Gung University, Taoyuan County, Taiwan, ⁹Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ¹⁰Tan Tock Seng Hospital, Singapore, Singapore, ¹¹Flinders University, Adelaide, Australia, ¹²Univ Dept of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong, ¹³Peking University International Hospital, Beijing, China, ¹⁴Melbourne University, Melbourne, Australia, ¹⁵Monash University, Melbourne, Australia

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: and SLE, Disease Activity, leukocytopenia,, Leukopenia

Session Information

Date: Monday, November 6, 2017

Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment Poster II: Damage and Comorbidities

Session Type: ACR Poster Session B

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

Background/Purpose: Leukopenia is commonly seen in SLE, but its predictors are not well understood, as it can be a result of disease activity or bone marrow suppression from immunosuppressive medications.

Methods: Data from 6071 visits in 1352 patients from a multinational lupus cohort were analysed. All patients met either ACR criteria (91%) or SLICC classification criteria (98.5%). Only patients with ≥2 visits were included in the analysis. Leukopenia was defined according to Common Terminology Criteria for Adverse Events (V3), of at least grade 2 (moderate) severity i.e. total white cell count<3 or lymphocyte count<0.8 or neutropenia<1.5. The generalised estimating equation method was used to examine longitudinal associations of leukopenia with factors including demographics (age, gender, ethnicity, SLE family history), serology (low complement/anti-dsDNA positivity), disease characteristics such as SLE Disease Activity Index (SLEDAI-2k) score, flare, physician global assessment (PGA), damage accrual Lupus Low Disease Activity State (LLDAS), and medication use.

Results: Thirty-five percent of patients had at least one episode of leukopenia over 1585 patient-years (24% of all visits). SLEDAI-2k≥6, flare, and PGA>1 were all significantly associated with increased odds of leukopenia (p<0.01). Low complement and high ESR were also significantly associated with leukopenia (p<0.01). In contrast, LLDAS was significantly associated with reduced odds of leukopenia, with an unadjusted odds ratio (OR) = 0.71, 95% CI 0.62-0.81, p<0.01.

The only immunosuppressant that was significantly associated with leukopenia was rituximab, OR 2.4, 95% CI 1.17-4.91, p=0.02. Azathioprine and leflunomide use had weak associations with leukopenia but did not reach statistical significance in univariable analysis (p-value 0.09 and 0.08 respectively). Neither methotrexate or mycophenolate use was associated with leukopenia. After adjustment in multivariable analysis models, statistically significant associations with leukopenia remained for SLEDAI≥6 (OR 1.33, 95% CI: 1.09 to 1.62; p <0.01), ESR>25 ( OR ESR>25 = 1.36, 95%CI 1.14-1.61; p<0.01), rituximab (OR 3.11, 95% CI 1.45-6.65; p<0.01) and azathioprine use (OR 1.58, 95% CI 1.24-2.01; p<0.01); the association of LLDAS with reduced odds of leukopenia also remained significant (OR = 0.56, 95% CI: 0.46 to 0.68; p-value<0.01).

Conclusion: SLE disease activity is a significant predictor of leukopenia, and leukopenia is negatively associated with LLDAS. Of the medications commonly used in SLE, rituximab and azathioprine were significantly associated with leukopenia.

Disclosure: R. Kandane-Rathnayake, None; V. Golder, None; W. Louthrenoo, None; S. Sockalingam, None; A. Lateef, None; Y. An, None; L. Zamora, None; Y. J. Wu, None; S. F. Luo, None; M. Chan, None; F. Goldblatt, None; C. S. Lau, None; Z. G. Li, None; S. V. Navarra, None; M. Nikpour, None; E. F. Morand, None; A. Y. Hoi, None.

To cite this abstract in AMA style:

Kandane-Rathnayake R, Golder V, Louthrenoo W, Sockalingam S, Lateef A, An Y, Zamora L, Wu YJ, Luo SF, Chan M, Goldblatt F, Lau CS, Li ZG, Navarra SV, Nikpour M, Morand EF, Hoi AY. Disease Activity Is an Independent Predictor of Leukopenia in a Large International SLE Cohort [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/disease-activity-is-an-independent-predictor-of-leukopenia-in-a-large-international-sle-cohort/. Accessed .

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