Session Information
Date: Tuesday, October 23, 2018
Title: Systemic Lupus Erythematosus – Clinical Poster III: Treatment
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Over the last few years, the importance of treating patients with systemic lupus erythematosus (SLE) towards achieving Remission or Low Disease Activity State has become the goal. Nevertheless, some patients remain with active disease despite full immunosuppressive drugs, and are usually called active refractory lupus. The present study was conducted to describe the clinical characteristics and treatment patterns for refractory lupus patients from a multi-ethnic, multicenter lupus cohort (GLADEL for Latin American Group for the Study of Lupus).
Methods: Between 1997 and 2005, GLADEL established an observational inception cohort constituted by more than 1400 SLE patients. This cohort comprises 34 centers with experience in SLE (tertiary referral centers with a lupus clinic, an academic profile and a rheumatology training program). Sociodemographic, clinical, immunological, treatment characteristics, disease activity and damage data were obtained at all visits. For the purpose of this study, refractory SLE was defined as patients with SLE Disease Activity Index (SLEDAI)−2K ≥6 points and a stable treatment regimen with fixed doses of prednisone ≥7.5 mg/day, or immunosuppressive drugs for at least 30 days at any point during follow up. The renal and CNS items of the SLEDAI−2K were not considered for scoring the SLEDAI-2K. Sociodemographic, clinical, immunological, treatment characteristics and disease activity are described as median (interquartile range, IR) and number (percentages); All analyses were performed using the SAS software, version 9.4 (SAS Institute, Cary, NC, USA).
Results: The cohort consisted of 1432 patients; 262 (18.3%) of them had refractory SLE. Of them, 229 (87.4%) were women and their median ages (diagnosis, refractory) were 27.0 and 28.8 years; 137 (52.3%) patients were Mestizos, 87 (33.2%) Caucasians and 29 (11.1%) were African-Latin Americans. Table 1 depicts these patients’ sociodemographic and SLEDAI−2K clinical and immunological characteristics, while Table 2 shows their patterns of treatment at time of being refractory.
Conclusion: In this pre-biologic period, refractory Latin American lupus patients presented most frequently with arthritis and new rash while they were treated with glucocorticoids, azatioprine and cyclophosphamide.
Table 1. Sociodemographic and SLEDAI clinical and immunological characteristics of GLADEL patients with refractory disease.
|
Variable, (n, %) |
Refractory lupus (n=262) |
|
Age at diagnosis, years, median |
27.0 (20.0-36.0) |
|
Age at refractory, years, median |
28.8 (21.5-36.6) |
|
Female |
229 (87.4) |
|
Ethnicity, |
|
|
Mestizo |
137 (52.3) |
|
Caucasian |
87 (33.2) |
|
African-Latin American |
29 (11.1) |
|
Socioeconomic status |
|
|
Low |
159 (60.9) |
|
Middle |
72 (27.6) |
|
High |
30 (11.5) |
|
Education |
|
|
0–7 years |
159 (60.9) |
|
8–12 years |
131 (51.8) |
|
>12 years |
49 (19.4) |
|
SLEDAI at refractory, median |
11 (8-19) |
|
SLEDAI items |
|
|
Vasculitis |
41 (15.7) |
|
Arthritis |
202 (77.1) |
|
Myositis |
5 (1.9) |
|
New rash |
114 (43.5) |
|
Alopecia |
98 (37.4) |
|
Mucosal ulcers |
60 (22.9) |
|
Pleurisy |
37 (14.1) |
|
Pericarditis |
29 (11.1) |
|
Low complement |
120 (45.8) |
|
Increased DNA binding |
113 (43.1) |
|
Fever |
58 (22.1) |
Table 2. Patterns of treatment in refractory patients from GLADEL.
|
Variable, (n, %) |
Refractory lupus (n=262) |
|
Antimalarials |
|
|
Added or increased |
22 (8.4) |
|
Stay on |
155 (59.2) |
|
Glucocorticoids (Prednisone dose or equivalent) any dose |
|
|
Added or increased |
22 (8.4) |
|
Stay on |
237 (90.5) |
|
Glucocorticoids (Prednisone dose or equivalent) > 20 mg/d |
145 (55.3) |
|
Azathioprine |
|
|
Added or increased |
68 (26.0) |
|
Stay on |
39 (14.9) |
|
Cyclophosphamide use |
|
|
Added or increased |
61 (23.3) |
|
Stay on |
29 (11.1) |
|
Cyclosporine |
|
|
Added or increased |
8 (3.1) |
|
Stay on |
4 (1.5) |
|
Methotrexate |
|
|
Added or increased |
19 (7.2) |
|
Stay on |
24 (9.2) |
To cite this abstract in AMA style:
Pons-Estel GJ, Scolnik M, Soriano ER, Harvey G, Quintana R, Garcia M, Saurit V, Drenkard C, Berbotto G, Sato E, Costallat L, Bonfa E, Borba EF, Tavares Brenol JC, da Silva NA, Cavalcanti A, Iglesias-Gamarra A, Guibert-Toledano M, Reyes GA, Massardo L, Neira O, Cardiel MH, Barile L, Amigo MC, Silveira LH, Garcia de la Torre I, Serrano RM, Acevedo-Vasquez E, Ugarte-Gil M, Segami I, Gervasoni V, Conti S, Chacón-Díaz R, Esteva-Spinetti MH, Pons-Estel BA. Patients Characteristics and Patters of Treatment in Refractory Systemic Lupus Erythematosus Patients in the Pre-Biologic Period: Data from a Multiethnic, Multinational Latin American Lupus Cohort [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/patients-characteristics-and-patters-of-treatment-in-refractory-systemic-lupus-erythematosus-patients-in-the-pre-biologic-period-data-from-a-multiethnic-multinational-latin-american-lupus-cohort/. Accessed .ACR Meeting Abstracts - https://acrabstracts.org/abstract/patients-characteristics-and-patters-of-treatment-in-refractory-systemic-lupus-erythematosus-patients-in-the-pre-biologic-period-data-from-a-multiethnic-multinational-latin-american-lupus-cohort/