ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2924

Effect of Antimalarials over the Different Domains of the Damage INDEX in Latin American SLE Patients

Guillermo J. Pons-Estel1, Daniel Wojdyla2, Graciela S. Alarcón3, Rosa Maria Serrano4, Rosana Quintana4, Manuel Ugarte-Gil5, Victor Pimentel-Quiroz5, Enrique R Soriano6, Marina Scolnik7, Monica Sacnun4, José A. Gómez-Puerta8, Mario H. Cardiel9, Virginia Pascual-Ramos10, Ignacio Garcia de la Torre11, Leonor Barile9, Luis H. Silveira12, Mary Carmen Amigo13, Maria Josefina Sauza del Pozo14, Marlene Guibert-Toledano15, Gil A. Reyes16, Antonio Iglesias Gamarra17, Luis Alonso Gonzalez18, Rosa Chacón-Díaz19, Maria H Esteva Spinetti20, Isaac Abadi20, Eduardo M. Acevedo-Vásquez21, Jose Alfaro-Lozano22, Maria Ines Segami23, Loreto Massardo24, Oscar Neira25, Emilia Sato26, Eloisa Bonfa27, Lilian Costallat28, Ricardo Xavier29, Fernando Cavalcanti30, Nilizio A. Da Silva31, Eduardo Ferreira Borba32, Luis J. Catoggio33, Joao C. Tavares Brenol29, Verónica Saurit34, Francisco Caeiro35, Alejandro Alvarellos34, Judith Sarano36, Mercedes Garcia37, Laura Onetti38, Cristina Drenkard39, Guillermo Berbotto40, Hugo R. Scherbarth41, Sergio Jacobelli24, Jose F Molina42, Gloria Vásquez42 and Bernardo Pons-Estel43, 1GLADEL, Rosario, Argentina, 2GLADEL consultant, Rosario, Argentina, 3University of Alabama at Birmingham, Birmingham, AL, 4Argentina, GLADEL, Rosario, Argentina, 5Peru, GLADEL, Lima, Peru, 6Argentina, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 7Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, CABA, Argentina, 8Colombia, GLADEL, Medellín, Colombia, 9GLADEL, Mexico, Mexico, 10Instituto Nacional de Ciencias Médicas y Nutrició, Mexico City, Mexico, 11Hospital General de Occidente, Guadalajara, Mexico, 12Rheumatology, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City DF, Mexico, 13Centro Medico ABC, Mexico, Mexico, 14Servicio de Reumatología, Instituto Mexicano de Seguro Social, Hospital de Especialidades Nº 25, Monterrey, Mexico, 15Centro de Investigaciones Médico Quirúrgicas, Habana, Centro de Investigaciones Médico Quirúrgicas, Habana, La Habana, Cuba, 16GLADEL, Havana, Cuba, 17Grupo de Inmunología Celular e Inmunogenética, Facultad de Medicina, Universidad de Antioquia, medellin, Colombia, 18Medicarte IPS, Medellín, Colombia, 19Servicio de Reumatología, Hospital Universitario de Caracas, Centro Nacional de Enfermedades Reumáticas, Caracas, Venezuela, 20GLADEL, Caracas, Venezuela (Bolivarian Republic of), 21Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru, 22Rheumatology, Hospital Guillermo Almenara Irigoyen. EsSalud, Lima, Peru, 23GLADEL, Lima, Peru, 24GLADEL, Santiago, Chile, 25Rheumatology Unit, Hospital del Salvador. Facultad de Medicina. Universidad de Chile, Santiago, Chile, 26Rheumatology Division, Universidade Federal de Sao Paulo, Sao Paulo, Brazil, 27Rheumatology Divison, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 28GLADEL, Brazil, Brazil, 29GLADEL, Porto Alegre, Brazil, 30GLADEL, Pernambuco, Brazil, 31GLADEL, Goias, Brazil, 32Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 33Rheumatology Unit, Internal Medicine Service. Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 34Rheumatology, Rheumatology Unit, Hospital Privado Universitario de Córdoba, Cordoba, Argentina, 35Rheumatology, Hospital Privado Centro Médico de Córdoba, Córdoba, Argentina, 36Rheumatology Unit, Instituto de Investigaciones Medicas Alfredo Lanari, Buenos Aires, Argentina, 37Rheumatology, HIGA General San Martin La Plata, La Plata, Argentina, 38GLADEL, Cordoba, Argentina, 39Division of Rheumatology, Emory University School of Medicine, Atlanta, GA, 40Sanatorio Británico, Rosario, Argentina, 41GLADEL, Mar del Plata, Argentina, 42GLADEL, Medellin, Colombia, 43GLADEL, Rosario, Santa Fe, Argentina

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords:

Session Information

Date: Wednesday, November 8, 2017

Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment V: Longterm Outcomes

Session Type: ACR Concurrent Abstract Session

Session Time: 9:00AM-10:30AM

Background/Purpose:

We have previously shown that Latin American SLE patients treated with Antimalarials (AMs) have a 25% lower risk of damage accrual than patients not receiving them1. The present study was conducted to assess the effects of AMs over the 12 items of the SLICC Damage Index, (SDI).

Methods:

Patients with a recent SLE diagnosis (≤2 years) from the GLADEL cohort were studied. End-point: Increase in the 12 items SDI since cohort entry.

Independent (socio-demographic, clinical laboratory and treatment) variables were included. The effect of AMs as a time dependent variable on items of the SDI (adjusting for potential confounders) was examined with a multivariable Cox regression model. Multivariate models were developed for the most common SDI items.

Results:

Of the 1,466 patients included in this analysis 1049 (72%) received AMs during follow-up (as defined); median exposure time: 30 months (Q1-Q3: 11–57 months). Total damage accrual occurred in 665 (45%) patients during a median follow up time of 24 months (Q1-Q3: 8-55) months. Within the 12 items of the SDI there were 301 integument, 208 renal, 149 neuropsychiatric, 98 musculoskeletal, 88 cardiovascular, 65 ocular, 43 pulmonary, 42 peripheral vascular, 33 gastrointestinal, 22 premature gonadal failure, 16 diabetes and 9 malignancy. After adjusting for potential confounders, at any time during follow-up a patient on AMs had a 35% and 30% lower risk of renal and neuropsychiatric damage accrual respectively than a patient not on AMs (adjusted HR 0.65, 95%CI 0.47–0.90 and HR 0.70, 95% CI 0.48–1.02). Such protective effect was not evident for integument, musculoskeletal and cardiovascular damage.

Conclusion:

After adjustment for possible confounding factors related to AMs use and damage accrual, AMs were independently associated with a reduced risk of renal and neuropsychiatric damage accrual in this cohort.

References:

1Pons-Estel G, Wojdyla D, Ugarte-Gil M, et al 192 Protective effect of antimalarials on the risk of damage accrual in systemic lupus erythematosus Lupus Science & Medicine 2017;4:doi: 10.1136/lupus-2017-000215.192

Table 1. Multivariable Cox proportional hazard model: Time-to-items damage accrual.

Endpoint

Unadjusted

Adjusted

HR1 95% CI

p-value

HR1 (95% CI)

p-value

Integument Damage

0.987 (0.763 – 1.277)

0.9223

0.971 (0.734 – 1.286)2

0.8381

Renal Damage

0.516 (0.385 – 0.692)

< 0.0001

0.652 (0.472 – 0.901)3

0.0094

Neuropsychiatric Damage

0.651 (0.458 – 0.925)

0.0167

0.701 (0.481 – 1.024)4

0.0660

Musculoskeletal Damage

0.838 (0.524 – 1.340)

0.4612

0.909 (0.561 – 1.473)5

0.6977

Cardiovascular Damage

0.562 (0.357 – 0.886)

0.0130

0.690 (0.430 – 1.107)6

0.1240

1 Hazard ratio for any antimalarial vs. no antimalarial in the previous month.

2 Adjusted for integument domain SDI at entry, hypertension, malar rash, discoid rash, proteinuria/cilindruria, hematologic disorder, glucocorticoid pulse and SLEDAI at cohort entry.

3 Adjusted for renal domain SDI at entry, age at diagnosis, socio-economic level, hypertension, proteinuria/cilindruria, immunosupressants and SLEDAI at cohort entry.

4 Adjusted for neurologic domain SDI at entry, glucocorticoid pulse, NSAIDs and SLEDAI at cohort entry.

5 Adjusted for musculoskeletal domain SDI at entry, gender, hypertension, discoid rash, oral/nasopharyngeal ulcerations, arthritis, neurologic disorder, glucocorticoids at cohort entry.

6 Adjusted for cardiovascular domain SDI at entry, disease duration, hypertension and serositis at cohort entry.

Disclosure: G. J. Pons-Estel, None; D. Wojdyla, None; G. S. Alarcón, None; R. M. Serrano, None; R. Quintana, None; M. Ugarte-Gil, None; V. Pimentel-Quiroz, None; E. R. Soriano, AbbVie, Janssen, Novartis, Pfizer Inc, UCB, 2,AbbVie, Janssen, Novartis, Pfizer Inc, UCB, 5,AbbVie, Bristol-Myers Squibb, Janssen, Novartis, Pfizer Inc, Roche, UCB, 8; M. Scolnik, None; M. Sacnun, None; J. A. Gómez-Puerta, None; M. H. Cardiel, None; V. Pascual-Ramos, None; I. Garcia de la Torre, None; L. Barile, None; L. H. Silveira, None; M. C. Amigo, None; M. J. Sauza del Pozo, None; M. Guibert-Toledano, None; G. A. Reyes, None; A. Iglesias Gamarra, None; L. A. Gonzalez, None; R. Chacón-Díaz, None; M. H. Esteva Spinetti, None; I. Abadi, None; E. M. Acevedo-Vásquez, None; J. Alfaro-Lozano, None; M. I. Segami, None; L. Massardo, None; O. Neira, None; E. Sato, None; E. Bonfa, None, 2; L. Costallat, None; R. Xavier, None; F. Cavalcanti, None; N. A. Da Silva, None; E. F. Borba, None; L. J. Catoggio, None; J. C. Tavares Brenol, None; V. Saurit, None; F. Caeiro, None; A. Alvarellos, None; J. Sarano, None; M. Garcia, None; L. Onetti, None; C. Drenkard, No commercial interest, 2; G. Berbotto, None; H. R. Scherbarth, None; S. Jacobelli, None; J. F. Molina, None; G. Vásquez, None; B. Pons-Estel, None.

To cite this abstract in AMA style:

Pons-Estel GJ, Wojdyla D, Alarcón GS, Serrano RM, Quintana R, Ugarte-Gil M, Pimentel-Quiroz V, Soriano ER, Scolnik M, Sacnun M, Gómez-Puerta JA, Cardiel MH, Pascual-Ramos V, Garcia de la Torre I, Barile L, Silveira LH, Amigo MC, Sauza del Pozo MJ, Guibert-Toledano M, Reyes GA, Iglesias Gamarra A, Gonzalez LA, Chacón-Díaz R, Esteva Spinetti MH, Abadi I, Acevedo-Vásquez EM, Alfaro-Lozano J, Segami MI, Massardo L, Neira O, Sato E, Bonfa E, Costallat L, Xavier R, Cavalcanti F, Da Silva NA, Borba EF, Catoggio LJ, Tavares Brenol JC, Saurit V, Caeiro F, Alvarellos A, Sarano J, Garcia M, Onetti L, Drenkard C, Berbotto G, Scherbarth HR, Jacobelli S, Molina JF, Vásquez G, Pons-Estel B. Effect of Antimalarials over the Different Domains of the Damage INDEX in Latin American SLE Patients [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/effect-of-antimalarials-over-the-different-domains-of-the-damage-index-in-latin-american-sle-patients/. Accessed .

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