ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 3

Is There an Association Between Persistently High Positive Antiphospholipid Antibody Profile and Organ Damage Accrual in Lupus Patients?

Doruk Erkan1, Lisa G. Criscione-Schreiber2, Maria Dall'era3, Olga Dvorkina4, Russell Griffin5, Galina Marder6, Maureen A. McMahon7, Jorge Sanchez-Guerrero8, Amit Saxena9 and Robert Roubey10, 1Rheumatology, Hospital for Special Surgery, New York, NY, 2Dept of Med/Rheum Div, Duke University School of Medicine, Durham, NC, 3Medicine/Rheumatology, University of California, San Francisco, San Francisco, CA, 4Medicine, SUNY Health Science Center at Brooklyn, Brooklyn, NY, 5University of Alabama at Birmingham, Birmingham, AL, 6Medicine, North Shore Long Island Health System, Great Neck, NY, 7Division of Rheumatology, UCLA David Geffen School of Medicine, Los Angeles, CA, 8UHN Toronto Western Hospital, Toronto, ON, Canada, 9Department of Medicine, Division of Rheumatology, New York University School of Medicine, New York, NY, 10Division of Rheumatology and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords:

Session Information

Title: Antiphospholipid Syndrome

Session Type: Abstract Submissions (ACR)

Background/Purpose: Few studies assessed the impact of antiphospholipid antibodies (aPL) on organ damage in lupus with conflicting results. Our objective was to determine if persistently high positive aPL profiles are associated with organ damage in lupus patients.

Methods: The Lupus Clinical Trials Consortium Inc. (LCTC) Lupus Data Registry consists of consecutively enrolled adults with lupus from 16 US and Canada centers, each contributing ~100 patients. Patients with at least 1 follow-up (f/u) visits who were tested for aPL were analyzed. We investigated the SLICC/ACR Damage Index (SDI) (baseline [BL] and f/u) and the aPL profile (lupus anticoagulant [LA], anticardiolipin antibody [aCL] IgG/M/A, and anti-β2Glycoprotein-I antibody [aβ2GPI]) (historically, BL, and f/u). “High Positive [HP] aPL” profile was defined as positive LA, aCL IgG/M/A≥40U, and/or aβ2GPI IgG/M/A≥40U. “Low Positive [LP] aPL” profile was negative LA, and aCL or aβ2GPI IgG/M/A above the laboratory range but <40U. “Negative aPL” was negative LA, and aCL and aβ2GPI IgG/M/A below the laboratory range. “Persistent aPL” was based on threshold levels of at least 50%, 60%, or 75% of the tests reported in HP or LP groups (based on ≥2 tests ≥12 weeks apart). A logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals for the association between an increase in SDI (first to last) and aPL-positivity adjusted for SDI at entry.

Results: Among 1506 patients, 1417 (94%) had at least 1 f/u visit, 1392/1417 (98%) had at least 1 aPL result, 1310/1392 (94%) had analyzable aPL (82 excluded; missing aCL/aβ2GPI levels), and 816/1310 (62%) had ≥2 tests ≥12 weeks apart, or at least 1 triple negative aPL result. Tables demonstrate the crude and adjusted odds ratios for SDI increase based on different SDI accrual points and aPL profiles.

Table 1.   Odds ratios* and 95% confidence intervals for the association between aPL   profile and SDI accrual of ≥ 1 points from baseline

Persistence   threshold

HP-Persistent

LP-Persistent

Negative

p-valuetrend

   ≥ 50%

 

 

 

 

      N (% with damage)

59   (23.7)

92   (13.0)

632   (24.7)

 

      Mean   follow-up (years)

1.69±0.78

1.98±0.64

1.65±0.81

 

      Crude

0.95 (0.51-1.78)

0.46 (0.24-0.86)

Referent

 

      Adjusted†

0.91 (0.47-1.74)

0.52 (0.27-0.99)

Referent

0.2535

   ≥ 60%

 

 

 

 

      N (% with damage)

14   (28.6)

73   (12.3)

696   (24.3)

 

      Mean   follow-up (years)

1.42±0.71

2.01±0.52

1.66±0.81

 

      Crude

1.25 (0.39-4.03)

0.44 (0.21-0.90)

Referent

 

      Adjusted†

1.02 (0.30-3.39)

0.49 (0.24-1.03)

Referent

0.1903

   ≥ 75%

 

 

 

 

      N (% with damage)

12   (33.3)

70   (12.9)

701   (24.1)

 

      Mean   follow-up (years)

1.38±0.70

2.00±0.63

1.67±0.80

 

      Crude

1.57 (0.47-5.29)

0.46 (0.23-0.96)

Referent

 

      Adjusted†

1.38 (0.40-4.80)

0.52 (0.25-1.08)

Referent

0.3458

*   Estimated from logistic regression – † Adjusted for SDI at study enrollment

 

Table 2.   Odds ratios* and 95% confidence intervals for the association between aPL   profile and damage accrual of ≥ 2 points from baseline

Persistence   threshold

HP-Persistent

LP-Persistent

Negative

p-valuetrend

   ≥ 50%

 

 

 

 

      N (% with damage)

61   (13.1)

100   (3.0)

649   (9.2)

 

      Mean   follow-up (years)

1.81±0.77

2.07±0.59

1.83±0.77

 

      Crude

1.48 (0.67-3.26)

0.30 (0.09-0.99)

Referent

 

      Adjusted†

1.52 (0.67-3.44)

0.36 (0.11-1.19)

Referent

0.8744

   ≥ 60%

 

 

 

 

      N (% with damage)

15   (26.7)

78   (3.9)

717   (8.9)

 

      Mean   follow-up (years)

1.46±0.76

2.10±0.56

1.84±0.76

 

      Crude

3.71   (1.15-11.99)

0.41 (0.13-1.33)

Referent

 

      Adjusted†

3.15 (0.94-10.56)

0.49 (0.15-1.63)

Referent

0.5129

   ≥ 75%

 

 

 

 

      N (% with damage)

13   (30.8)

75   (4.0)

722   (8.9)

 

      Mean   follow-up (years)

1.42±0.75

2.09±0.57

1.85±0.76

 

      Crude

4.57   (1.37-15.25)

0.43 (0.13-1.40)

Referent

 

      Adjusted†

4.13   (1.19-14.36)

0.51 (0.15-1.69)

Referent

0.3576

*   Estimated from logistic regression – † Adjusted for SLICC at study enrollment

 

Table 3.   Odds ratios* and 95% confidence intervals for the association between aPL   profile and SDI accrual of ≥ 3 points from baseline

Persistence   threshold

HP – Persistent

LP – Persistent

Negative

p-valuetrend

   ≥ 50%

 

 

 

 

      N (% with damage)

62   (8.1)

103   (4.9)

651   (4.5)

 

      Mean   follow-up (years)

1.87±0.74

2.05±0.59

1.88±0.75

 

      Crude

1.88 (0.70-5.05)

1.09 (0.41-2.89)

Referent

 

      Adjusted†

1.95 (0.70-5.43)

1.40 (0.51-3.85)

Referent

0.1730

   ≥ 60%

 

 

 

 

      N (% with damage)

17   (17.7)

81   (6.2)

718   (4.3)

 

      Mean   follow-up (years)

1.73±0.74

2.08±0.57

1.88±0.75

 

      Crude

4.75   (1.30-17.39)

1.46 (0.55-3.86)

Referent

 

      Adjusted†

3.77 (0.99-14.39)

1.88 (0.69-5.17)

Referent

0.0283

   ≥ 75%

 

 

 

 

      N (% with damage)

14   (14.3)

78   (6.4)

724   (4.4)

 

      Mean   follow-up (years)

1.68±0.73

2.06±0.58

1.89±0.75

 

      Crude

3.60 (0.77-16.78)

1.48 (0.56-3.92)

Referent

 

      Adjusted†

2.92 (0.60-14.30)

1.89 (0.69-5.17)

Referent

0.0822

*   Estimated from logistic regression -† Adjusted for SDI at study enrollment

Conclusion: Our results suggest that persistently high aPL profiles, particularly those with higher thresholds for persistence, are associated with higher (≥2 or ≥3 points) SDI score accrual in lupus patients. Given the small number of patients with persistently high aPL profiles, limited analysis of potential confounders, and possibility of confounding by indication (more frequent aPL testing in patients with more severe disease/damage), further analysis of the LCTC Lupus Data Registry will clarify if aPL is a risk factor for or rather a marker of organ damage.

Disclosure:

D. Erkan,

Lupus Clinical Trials Consortium,

2;

L. G. Criscione-Schreiber,

Lupus Clinical Trials Consortium,

2;

M. Dall’era,

Lupus Clinical Trials Consortium LCTC,

2;

O. Dvorkina,

Lupus Clinical Trials Consortium,

2;

R. Griffin,

Lupus Clinical Trials Consortium,

2;

G. Marder,

Lupus Clinical Trials Consortium LCTC,

2;

M. A. McMahon,

Lupus Clinical Trials Consortium LCTC,

2;

J. Sanchez-Guerrero,

Lupus Clinical Trials Consortium LCTC,

2;

A. Saxena,

Lupus Clinical Trials Consortium,

2;

R. Roubey,

Lupus Clinical Trials Consortium LCTC,

2.

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