Incidence and Predictors of Atherosclerotic Vascular Events in a Multicentre Inception SLE Cohort - ACR Meeting Abstracts

Abstract Number: 1573

Incidence and Predictors of Atherosclerotic Vascular Events in a Multicentre Inception SLE Cohort

Murray Urowitz¹, Dafna Gladman ², Jiandong Su ¹, Vernon Farewell ³, Jorge Sanchez-Guerrero ⁴, Juanita Romero-Diaz ⁵, Sang-Cheol Bae ⁶, Paul Fortin ⁷, Ola Nived ⁸, Ann E Clarke ⁹, Sasha Bernatsky ¹⁰, Caroline Gordon ¹¹, John Hanly ¹², Daniel J Wallace ¹³, David A Isenberg ¹⁴, Anisur Rahman ¹⁵, Joan Merrill ¹⁶, Ellen M Ginzler ¹⁷, Graciela Alarcon ¹⁸, Michelle Petri ¹⁹, Ian Bruce ²⁰, Munther A Khamashta ²¹, Cynthia Aranow ²², Susan Manzi ²³, MA Dooley ²⁴, Rosalind Ramsey-Goldman ²⁵, Andreas Jönsen ⁸, Kristjan Steinsson ²⁶, Asad Zoma ²⁷, Guillermo Ruiz-Irastorza ²⁸, S Sam Lim ²⁹, Kenneth C Kalunian ³⁰, Murat Inanc ³¹, Ronald van Vollenhoven ³², Manuel Ramos ³³, Diane Kamen ³⁴, Soren Jacobsen ³⁵, Christine Peschken ³⁶, Anca Askanase ³⁷ and Thomas Stoll ³⁸, ¹University Health Network, University of Toronto, Toronto, ON, Canada, ²Toronto Western Hospital, Toronto, Canada, Toronto, ON, Canada, ³University of Cambridge, Cambridge, United Kingdom, ⁴Toronto Western Hospital, Toronto, ON, Canada, ⁵Instituto Nacional de Ciencias Medicas y Nutricion Salvador, Zubiran Vasco de Quiroga, Mexico City, Mexico, ⁶Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea, ⁷Division de Rhumatologie, Département de Médecine, CHU de Québec – Université Laval, Axe maladies infectieuses et inflammatoires, Centre de recherche du CHU de Québec – Université Laval, Canada, Quebec, QC, Canada, ⁸Lund University, Lund, Sweden, ⁹University of Calgary, Calgary, AB, Canada, ¹⁰Research Institute of the McGill University Health Centre, Montreal, QC, Canada, ¹¹University of Birmingham, Birmingham, United Kingdom, ¹²Queen Elizabeth II Health Science Centre (Nova Scotia Rehab Site), Halifax, NS, Canada, ¹³Cedars-Sinai Medical Centre, Beverly Hills, CA, ¹⁴Centre for Rheumatology, London, United Kingdom, ¹⁵University College London, London, United Kingdom, ¹⁶Oklahoma Medical Research Foundation, Oklahoma City, ¹⁷State University of New York Downstate Medical Center, Brooklyn, NY, ¹⁸The University of Alabama at Birmingham, Birmingham, AL, ¹⁹Johns Hopkins University School of Medicine, Baltimore, MD, ²⁰University of Manchester, Manchester, United Kingdom, Manchester, England, United Kingdom, ²¹King's College London School of Medicine, London, United Kingdom, ²²Feinstein Institute for Medical Research, Manhasset, NY, ²³Allegheny Health Network, Pittsburg, PA, ²⁴UnC Kidney Centre, Chapel Hill, NC, ²⁵Northwestern University, Chicago, IL, ²⁶Landspitali, University Hospital, Reykjavik, Iceland, ²⁷Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, United Kingdom, ²⁸Unidad de Enfermedades Autoinmunes, BioCruces Health Research Institute, Bizkaia, Spain, ²⁹Emory University, Atlanta, GA, ³⁰UC San Diego School of Medicine, LaJolla, CA, ³¹Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey, ³²Amsterdam Rheumatology and Immunology Center ARC, Amsterdam, the Netherlands, Amsterdam, Netherlands, ³³Department of Internal Medicine, Hospital Nuestra Señora del Prado, Talavera, Talavera, Spain, Talavera, Spain, ³⁴Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA., Charleston, SC, ³⁵Copenhagen Lupus and Vasculitis Clinic, Copenhagen, Denmark, ³⁶University of Manitoba, Winnipeg, Canada, ³⁷Columbia University Medical Center, New York, NY, ³⁸University of Glasgow, Kilbride, Scotland, United Kingdom

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: Atherosclerosis, Lupus and SLE, Systemic lupus erythematosus (SLE)

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: The prevalence of atherosclerotic vascular events (AVE) in published literature of an inception cohort with SLE is 10%. We aimed to investigate the accrual and the associated factors of AVE in a multinational multiethnic inception cohort of patients with SLE.

Methods: A large 33-centre multinational inception cohort of SLE patients was followed yearly according to a standardized protocol between 1999-2017. Patients (≥4 ACR criteria) entered the cohort within 15 months of SLE diagnosis. Patients with at least one follow-up visit after enrolment were identified. AVEs were collected and attributed on a specialized form. Diagnosis of AVE was confirmed using standard clinical criteria, relevant laboratory data and imaging. Attribution to atherosclerosis (AS) was made on the basis of SLE being inactive at the time of the event, and/or the presence of typical AS changes on imaging or pathology and/or evidence of AS elsewhere. Analysis included descriptive statistics, prevalence, rate of AVE’s per 1000 patient-years of follow-up and univariable / multivariable time-dependent survival regressions.

Results: Of the 1848 patients enrolled in the cohort, 1710 who had at least one follow up visit and comprised the study sample. 88.6% were female, 49.4% Caucasian, 16.4% Black, 15.0% Asian, 15.5% Hispanic and 3.7% other. At enrolment mean (SD) disease duration was 5.7 ± 4.2 months, age rolment was 35.2 ± 13.4 years and SLEDAI-2K was 5.4 ± 5.4. The prevalence of AVEs was 3.6% and the rate per 1000-patient years was 4.6. Sixty-one patients had atherosclerotic events after enrolment (Table 1). Univariate time-dependent Cox regression revealed the predictive factors for AVE were female sex, average steroid dose and antimalarial treatment. Multivariable analyses confirmed female gender had an independent protective effect [hazard ratio and 95% confidence interval [HR (95%CI)] [0.531 (0.288, 0.992)], as did antimalarial treatment [0.517 (0.306, 0.874)] (Table 2). Since only 1305 patients had been tested for antiphospholipid antibodies (APLA) this analysis was repeated in those patients with APLA results. In these patients in the multivariable analysis female sex and antimalarial therapy were protective and APLA, SLEDAI-2K and BMI were predictive (results not shown).

Conclusion: The prevalence of AVE in this study is much lower than previously published data. Female sex and antimalarials were protective for AVE. In patients with APLA similar factors were protective but the APLA, SLEDAI-2K and BMI were predictive for AVE. In clinical practice all classic risk factors should be monitored and treated as they are in the general population.

Disclosure: M. Urowitz, Janssen Research & Development, LLC, 2, UCB Pharma, 9; D. Gladman, AbbVie, 2, 5, Amgen, 2, 5, BMS, 5, Celgene, 2, 5, Eli Lilly, 2, 5, Galapagos, 5, Galapagos NV, 5, Gilead, 5, GSI, 5, Janssen, 5, Janssen Research & Development, LLC, 2, Novartis, 2, 5, Pfizer, 2, 5, UCB, 2, 5; J. Su, None; V. Farewell, None; J. Sanchez-Guerrero, None; J. Romero-Diaz, None; S. Bae, None; P. Fortin, None; O. Nived, None; A. Clarke, AstraZeneca/MedImmune, 5, Bristol-Myers Squibb, 5, Exagen Diagnostics, 5; S. Bernatsky, None; C. Gordon, Bristol-Myers Squibb, 5, 8, Centers for Disease Control and Prevention, 5, Eli Lilly, 5, 8, EMD Serono, 5, EMD Serono, UCB, 5, GlaxoSmithKline, 5, 8, Merck Serono, 5, 8, UCB, 2, 5, 8, Versus Arthritis/GSK, 2; J. Hanly, None; D. Wallace, None; D. Isenberg, None; A. Rahman, None; J. Merrill, Xencor, 2; E. Ginzler, Ablynx, 5, Aurinia, 2, Genentech, 2, GlaxoSmithKline, 2, Guidepoint Global Gerson Lerman Group, 5, Janssen, 5; G. Alarcon, None; M. Petri, Eli Lilly and Company, 5, Exagen, 2, 5; I. Bruce, Astra Zenica, 5, AstraZeneca, 5, Eli Lilly, 5, 8, Genzyme Sanofi, 2, GlaxoSmithKline, 2, 5, 8, GSK, 2, 5, 8, ILTOO, 5, Iltoo, 5, MedImmune, 5, 8, Medimmune, 5, Merck Serono, 5, 8, Merk Serono, 5, Roche, 5, 8, Sanofi Genzyme, 2, UCB, 2, 5, 8, UCB Pharma, 5, 8; M. Khamashta, None; C. Aranow, EMD Serrono, 2, GlaxoSmithKline, 2, Janssen, 2, Takeda, 2, UCB, Inc, 2, Xencor, 2; S. Manzi, Allegheny Health Network, 3, AstraZeneca, 2, 5; M. Dooley, None; R. Ramsey-Goldman, Exagen, 2; A. Jönsen, None; K. Steinsson, None; A. Zoma, None; G. Ruiz-Irastorza, None; S. Lim, None; K. Kalunian, Ablynx, 2, Anthera, 5, Bristol-Myers Squibb, 2, 5, Eli Lilly, 5, Equillium, 5, Exagen Diagnostics, 5, Genentech, 5, Human Genome Sciences/GlaxoSmithKline, 2, Kyowa Hakko Kirin, 2, Pfizer, 2, Takeda, 2, UCB, 2; M. Inanc, None; R. van Vollenhoven, AbbVie, 2, 9, Arthrogen, 2, AstraZeneca, 9, Biotest, 9, BMS, 2, 9, Celgene, 9, GSK, 2, 9, Janssen, 9, Lilly, 2, 9, medac, 9, Merck, 9, Novartis, 9, Pfizer, 2, 9, Roche, 9, UCB, 2, 9; M. Ramos, None; D. Kamen, None; S. Jacobsen, None; C. Peschken, Astra Zeneca, 2, Celgene, 2, Janssen, 2; A. Askanase, None; T. Stoll, None.

To cite this abstract in AMA style:

Urowitz M, Gladman D, Su J, Farewell V, Sanchez-Guerrero J, Romero-Diaz J, Bae S, Fortin P, Nived O, Clarke A, Bernatsky S, Gordon C, Hanly J, Wallace D, Isenberg D, Rahman A, Merrill J, Ginzler E, Alarcon G, Petri M, Bruce I, Khamashta M, Aranow C, Manzi S, Dooley M, Ramsey-Goldman R, Jönsen A, Steinsson K, Zoma A, Ruiz-Irastorza G, Lim S, Kalunian K, Inanc M, van Vollenhoven R, Ramos M, Kamen D, Jacobsen S, Peschken C, Askanase A, Stoll T. Incidence and Predictors of Atherosclerotic Vascular Events in a Multicentre Inception SLE Cohort [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/incidence-and-predictors-of-atherosclerotic-vascular-events-in-a-multicentre-inception-sle-cohort/. Accessed .

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