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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)

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Session Information

Date: Monday, November 11, 2019

Session 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 December 12, 2019.
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