Factors Associated with Damage Accrual in SLE Patients with No Clinical or Serological Disease Activity

Diane Apostolopoulos¹, Rangi Kandane-Rathnayake ¹, Worawit Louthrenoo ², Shue Fen Luo ³, Yeong-Jian Wu ³, Aisha Lateef ⁴, Vera Golder ¹, Sargunan Sockalingam ⁵, Sandra Navarra ⁶, Leonid Zamora ⁷, Laniyati Hamijoyo ⁸, Yasuhiro Katsumata ⁹, Masayoshi Harigai ⁹, Madelynn Chan ¹⁰, Sean O'Neill ¹¹, Fiona Goldblatt ¹², Chak Sing Lau ¹³, Alberta Hoi ¹⁴, Mandana Nikpour ¹⁵ and Eric Morand ¹⁶, ¹Monash University, Melbourne, Australia, ²Chiang Mai University Hospital, Chiang Mai, Thailand, ³Chang Gung Memorial Hospital, Guishan, Taiwan (Republic of China), ⁴National University Hospital, Singapore, Singapore, ⁵University of Malaya, Kuala Lumpur, Malaysia, ⁶University of Santo Tomas Hospital, Manila, Philippines, ⁷Santo Tomas Hospital, Manila, Philippines, ⁸Padjadjaran University, Bandung, Indonesia, ⁹Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Tokyo, Japan, ¹⁰Tan Tock Seng Hospital, Singapore, Singapore, ¹¹University of NSW, Ingham Institute of Applied Medical Research, Sydney, Australia, ¹²Royal Adelaide Hospital, Adelaide, Australia, ¹³Hong Kong University, Hong Kong, Hong Kong, ¹⁴School of Clinical Sciences, Monash University, Meloburne, Victoria, Australia, ¹⁵St Vincent's Hospital, Melbourne; The University of Melbourne, Melbourne, Australia, ¹⁶Monash University, Melbourne, Victoria, Australia

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: glucocorticoids and outcome measures, Lupus

Session Information

Date: Monday, November 11, 2019

Title: SLE – Clinical Poster II: Comorbidities

Session Type: Poster Session (Monday)

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

Background/Purpose: Accrual of irreversible organ damage is a major risk factor for death in SLE. While unmodifiable factors, such as age at disease onset and ethnicity, are associated with increased damage accrual in SLE, disease activity and medications, in particular glucocorticoids, are also associated. Understanding the independent contribution of glucocorticoid use to organ damage in SLE is confounded by the fact that glucocorticoid use is associated with active disease. We determined factors contributing to the risk of damage accrual in SLE independent of disease activity by studying patients who had no measurable disease activity.

Methods: SLE patients were prospectively recruited from 13 centres in 8 countries and followed longitudinally between 2013-2016. Disease activity (SLEDAI-2K) and treatment details were recorded at each visit, and organ damage measured annually (SDI). Cox-proportional hazards analyses were used to examine time-dependent associations of variables with damage accrual. The absence of disease activity was defined as time-adjusted mean (TAM)-SLEDAI-2K=0.

Results: 1707 patients were studied. Patient characteristics are shown in Table 1. 157 patients (9%) had no clinical or serological disease activity for the entire study period (TAM-SLEDAI-2K=0). Prednisolone exposure was 66% (103/157) in this group, with a median TAM-prednisolone dose of 2.0mg/day (0.0-5.9). Forty-one per cent (65/157) of patients had irreversible organ damage at baseline. Despite SLEDAI-2K=0 throughout, accrual of irreversible organ damage occurred in 13% of this subset, with 21 events captured over a median (IQR) 1.9 (1.0-2.3) years follow-up. In univariable analysis of time-adjusted mean variables, prednisolone exposure was associated with damage accrual (HR 1.1, 95% CI 1.0-1.3, p=0.05), as was physician global assessment (PGA) (HR 1.15, 95% CI 1.0-1.3, p=0.01). Baseline SDI organ damage, gender and ethnicity were not associated with damage accrual in this subset (Table 2). In multivariable analysis, damage accrual was independently associated with prednisolone exposure (HR 1.14, 95% CI 1.03-1.25, p=0.01), physician global assessment (PGA) (HR 1.13, 95% CI 1.03-1.23, p=0.01) and age at enrolment (HR 1.04, 95% CI 1.01-1.07, p< 0.02) (Table 3).

Conclusion: Irreversible damage accrual occurs in SLE patients with no clinical or serological disease activity as captured by SLEDAI-2K. Glucocorticoid use contributes to the risk of organ damage in these patients. These findings confirm an independent contribution of glucocorticoid use to organ damage accrual in SLE.

table1

Table 1 – Baseline Patient and Disease Characteristics

table2

Table 2 – Univariable associations of damage accrual in patients with no clinical or serological disease activity as measured by SLEDAI-2K throughout the study period -N=157-

table3

Table 3 – Multivariable associations of damage accrual in patients with no clinical or serological disease acitivity measured by SLEDAI-2K throughout the study period -N=157-

Disclosure: D. Apostolopoulos, None; R. Kandane-Rathnayake, None; W. Louthrenoo, None; S. Luo, None; Y. Wu, None; A. Lateef, None; V. Golder, None; S. Sockalingam, None; S. Navarra, Abbott, 8, Abbott, Astellas, Johnson & Johnson, Novartis, Pfizer, 8, Astellas, 8, Johnson & Johnson, 8, Novartis, 8, Pfizer, 8; L. Zamora, None; L. Hamijoyo, None; Y. Katsumata, None; M. Harigai, AbbVie Japan GK, 2, 8, Ayumi Pharmaceutical Co. Ltd., 2, Bristol Meyers Squib, 2, 5, 8, Bristol-Myers Squibb Co. Ltd, 2, 5, 8, Chugai Pharmaceutical Co. Ltd., 2, 5, 8, Chugai Pharmaceutical Co., Ltd., 2, 5, 8, Eisai Co. Ltd., 2, Eisai Co., Ltd., 2, Eli Lilly, 5, 8, Mitsubishi Tanabe Pharma Co., 2, Mitsubishi Tanabe Pharma Corp., 2, Nippon Kayaku Co. Ltd., 2, Taisho Toyama Pharmaceutical Co. Ltd., 2, Takeda Pharmaceutical Co., 2, Takeda Pharmaceutical Co., Ltd., 2, Teijin Pharma Ltd., 2, 8, Teijin Pharma, Ltd., 2, 8; M. Chan, None; S. O'Neill, None; F. Goldblatt, None; C. Lau, None; A. Hoi, Merck, 2; M. Nikpour, Actelion, 2, Arthritis Australia, 2, Australian Rheumatology Association, 2, Bayer, 2, BMS, 2, GSK, 2, Pfizer, 2, Roche, 2, Scleroderma Victoria and Australia, 2, St Vincent's Hospital Melbourne Research Endowment Fund, 2; E. Morand, AstraZeneca, 2, 5, 8, Bristol Myers Squibb, 2, Eli Lilly, 5, Janssen, 2, 5, Merck Serono, 2, 5, UCB, 2.

To cite this abstract in AMA style:

Apostolopoulos D, Kandane-Rathnayake R, Louthrenoo W, Luo S, Wu Y, Lateef A, Golder V, Sockalingam S, Navarra S, Zamora L, Hamijoyo L, Katsumata Y, Harigai M, Chan M, O'Neill S, Goldblatt F, Lau C, Hoi A, Nikpour M, Morand E. Factors Associated with Damage Accrual in SLE Patients with No Clinical or Serological Disease Activity [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/factors-associated-with-damage-accrual-in-sle-patients-with-no-clinical-or-serological-disease-activity/. Accessed .

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