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Abstract Number: 1289

Patients Enrolled in the Accelerating Medicines Partnership (AMP) RA/SLE Network with Isolated Renal Disease Report Minimal Quality of Life Impairment on PROMIS-29 Compared to Patients with Extrarenal Symptoms

Philip Carlucci1, Jessica Li2, Heather Gold3, Kristina Deonaraine1, Andrea Fava2, Jill Buyon4, Judith James5, Chaim Putterman6, Deepak Rao7, Betty Diamond8, Derek Fine2, Jose Monroy-Trujillo2, Kristin Haag9, Accelerating Medicines Partership (AMP) RA/SLE Network10, H. Michael Belmont4, Sean Connery11, Fernanda Payan-Schober12, Richard Furie13, Celine Berthier14, Maria Dall'Era15, Kerry Cho16, Diane Kamen17, Kenneth Kalunian18, The Accelerating Medicines Parternship In SLE Network19, Peter Izmirly1 and Michelle Petri20, 1New York University School of Medicine, New York, NY, 2Johns Hopkins University, Baltimore, MD, 3NYU Grossman School of Medicine, New York, NY, 4NYU School of Medicine, New York, NY, 5Oklahoma Medical Research Foundation, Oklahoma City, OK, 6Albert Einstein College of Medicine, Bronx, NY, 7Brigham and Women's Hospital, Boston, MA, 8Northwell Health, Manhasset, NY, 9Johns Hopkins School of Medicine, Baltimore, MD, 10Brigham and Women's Hospital, Everett, MA, 11Texas Tech University Health Sciences Center, Texas, TX, 12Texas Tech University Health Sciences Center, El Paso, TX, 13Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, 14University of Michigan, Ann Arbor, MI, 15University of California San Francisco, Corte Madera, CA, 16University of California San Francisco, San Francisco, CA, 17Medical University of South Carolina, Charleston, SC, 18UC San Diego, La Jolla, CA, 19Multiple Institutions, Multiple Cities, 20Johns Hopkins University School of Medicine, Baltimore, MD

Meeting: ACR Convergence 2021

Keywords: Lupus nephritis, promis-29, quality of life, Renal, Systemic lupus erythematosus (SLE)

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Session Information

Date: Monday, November 8, 2021

Session Title: SLE – Diagnosis, Manifestations, & Outcomes Poster III: Outcomes (1257–1303)

Session Type: Poster Session C

Session Time: 8:30AM-10:30AM

Background/Purpose: Lupus nephritis can occur as an isolated component of disease activity or be accompanied by diverse extrarenal symptoms that can adversely affect a patient’s quality of life (QOL). Whether renal disease absent other activity is sufficient to decrease QOL is unknown. A lack of reported QOL impairment may place patients at risk for delayed diagnosis of nephritis or medication noncompliance yet nephritis trials have largely neglected QOL. As such, this study leveraged the multi-center multi-racial Accelerating Medicines Partnership (AMP) lupus nephritis cohort to assess QOL measured by PROMIS-29.

Methods: Patients (n=182) fulfilling ACR or SLICC criteria for SLE with a uPCR > .5 and biopsy Class III, IV, V, or mixed were consecutively enrolled in AMP at the time of renal biopsy and clinical history, PROMIS-29, and disease activity as assessed by the hybrid SELENA-SLEDAI were recorded. Patients were determined to have extrarenal clinical activity if, after excluding all laboratory parameters from the SLEDAI, the score remained > 1. Raw PROMIS-29 scores were transformed to t-scores with the mean of 50 + 10 representing the US population and a difference of 5 points considered clinically meaningful. PROMIS-29 physical and mental health summary scores were calculated according to published formulas.

Results: Forty-three percent of patients (n=78) had extrarenal clinical manifestations including vasculitis (4%), arthritis (39%), rash (45%), alopecia (42%), mucosal ulcers (13%), pleurisy (12%), pericarditis (8%), and fever (4%). Patients with isolated renal disease (n=104, 57%) did not have PROMIS-29 scores that differed clinically from the US population whereas patients with extrarenal disease reported deficits in physical functioning, fatigue, social functioning, and pain (Table 1). Patients with extrarenal disease had significantly lower physical health summary scores compared to patients with isolated disease (median [IQR]: 40.31 [35.79, 47.02] p< 0.001 vs. 48.6 [40.14, 57.08]) and significantly lower mental health summary scores (44.12 [38.63, 51.39], p=0.024 vs. 48.67 [40.51, 55.07]). Female and African American patients and those with nephrotic range proteinuria or undergoing first biopsy had significantly lower physical health summary scores, but mental health summary scores did not differ by these variables. Patients on greater than 20 mg of prednisone had both significantly lower physical and mental health summary scores compared to those on lower doses. PROMIS-29 scores did not differ by low complements, anti-dsDNA, or anti-Ro antibodies. Stepwise multivariable linear regression analysis demonstrated that the association between extrarenal disease and lower PROMIS-29 summary scores was primarily driven by arthritis and independent of potential confounders (Tables 2 and 3).

Conclusion: The majority of patients had isolated renal disease and report a QOL similar to that of the general population. In contrast, those with extrarenal manifestations report significantly worse QOL outcomes. These results reinforce the critical importance of routine laboratory surveillance and medication compliance for nephritis even in patients with seemingly quiescent clinical disease.


Disclosures: P. Carlucci, None; J. Li, None; H. Gold, None; K. Deonaraine, None; A. Fava, None; J. Buyon, Bristol Myers Squibb, 1, GlaxoSmithKline, 2, Janssen, 2, Ventus, 2, Equillium, 2; J. James, Progentec Diagnostics, Inc., 2; C. Putterman, equllium, 2, 5, Progentec, 2, Kidneycure, 2; D. Rao, Janssen, 5, 6, Bristol-Myers Squibb, 1, 5, Scipher Medicine, 2, Pfizer, 6, Merck, 6; B. Diamond, ISD, 2, nextcure, 2, J5J, 2, astlia, 2, dbv, 2, cyxone, 2; D. Fine, None; J. Monroy-Trujillo, None; K. Haag, None; A. (AMP) RA/SLE Network, None; H. Belmont, Alexion, 6; S. Connery, None; F. Payan-Schober, None; R. Furie, GlaxoSmithKline, 2, 5; C. Berthier, None; M. Dall'Era, AstraZeneca, 2, Aurinia, 2, Biogen, 2, Bristol Myers Squibb, 2, GlaxoSmithKline, 2, Pfizer, 2; K. Cho, None; D. Kamen, None; K. Kalunian, Amgen, 2, AbbVie, 2, AstraZeneca, 2, Biogen, 2, Bristol Myers Squibb, 2, Eli Lilly, 2, Equillium, 2, Genentech/Roche, 2, Gilead, 2, Janssen, 2, Lupus Research, 5, Pfizer, 5, Sanford Consortium, 5, Vielabio, 2, Aurinia, 2, Alliance, 2, Nektar, 2; T. In SLE Network, None; P. Izmirly, Momenta/Janssen, 1; M. Petri, Alexion, 1, Amgen, 1, Astrazeneca, 1, 5, Aurinia, 5, 6, Eli Lilly, 5, Emergent Biosolutions, 1, Exagen, 5, Gilead Biosciences, 2, GSK, 1, 5, IQVIA, 1, Idorsia Pharmaceuticals, 2, Janssen, 1, 5, Merck EMD Serono, 1, Momenta Pharmaceuticals, 2, PPD Development, 1, Sanofi, 2, Thermofisher, 5, UCB Pharmaceuticals, 2.

To cite this abstract in AMA style:

Carlucci P, Li J, Gold H, Deonaraine K, Fava A, Buyon J, James J, Putterman C, Rao D, Diamond B, Fine D, Monroy-Trujillo J, Haag K, (AMP) RA/SLE Network A, Belmont H, Connery S, Payan-Schober F, Furie R, Berthier C, Dall'Era M, Cho K, Kamen D, Kalunian K, In SLE Network T, Izmirly P, Petri M. Patients Enrolled in the Accelerating Medicines Partnership (AMP) RA/SLE Network with Isolated Renal Disease Report Minimal Quality of Life Impairment on PROMIS-29 Compared to Patients with Extrarenal Symptoms [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/patients-enrolled-in-the-accelerating-medicines-partnership-amp-ra-sle-network-with-isolated-renal-disease-report-minimal-quality-of-life-impairment-on-promis-29-compared-to-patients-with-extrarenal/. Accessed January 30, 2023.
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