Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
morbidity and mortality among patients with systemic lupus erythematous (SLE).
Studies have demonstrated efficacy and safety for mycophenolate mofetil (MMF) in
LN, but use of MMF for extra-renal manifestations of SLE has not been as
well-described as for azathioprine (AZA). This study was conducted to assess
whether use of either MMF or AZA for extra-renal manifestations of SLE protects
against development of future LN and whether treatment affects vary depending
on age of SLE onset.
collected on patients with SLE consented and enrolled in a longitudinal
registry started in 2003. Data included, but were not limited to,
medication use and changes over time, medical history, and demographics.
To assess the effects of treatment and the potential modification of treatment
effect by age of SLE onset, Cox proportion-hazards modeling, controlling for
gender, race, and hydroxychloroquine use, was utilized- allowing treatment to
vary over time.
Of the 533
patients with SLE, 90.4% were female and 76.7% were African American. The
average age at SLE onset was 30.4 years (sd = 13.7) with a range of 3 to 76
years of age. Among those diagnosed with LN (n = 251, 47.1%), the average
time between diagnosis of SLE and LN was 6.3 years (sd = 5.4) with a range of
less than a year to more than thirty years.
patients taking MMF or AZA to those not taking either: there is no increased
risk of developing LN for patients taking either medications at decade-ages 10
and 20; for MMF, there was no statistically or clinically significant increased
risk of developing LN at decade-ages 30 and 40; for AZA, there is a clinical
risk and, at decade-age 40, a statistically significant risk of developing
renal disease; for both, AZA and MMF, there is an upward trend of the risk
estimates as age of SLE onset increases. When comparing AZA to MMF usage,
there was no clinical or statistical difference found at any decade-age.
Moreover, when comparing AZA to MMF usage, there is trend from indifference in
treatment benefit to MMF benefit over AZA around decade-ages 30 and 40.
large registry of patients with SLE, we found increasing use of MMF for
extra-renal manifestations of SLE. For patients diagnosed with SLE at a later
age, our data suggests that MMF has a protective effect over AZA in preventing
future LN. Although this same protective effect was not seen within
patients with childhood-onset SLE, MMF was prescribed to patients across all
ages who were at higher risk of LN, suggesting a possible protective effect
which should be explored in prospective studies.
To cite this abstract in AMA style:Hyer JM, Wolf B, Oates J, Gilkeson GS, Kamen DL. Treatment Patterns Differ Based on Age of Systemic Lupus Erythematosus Onset: A Comparison of Azathioprine and Mycophenolate on the Prevention of Lupus Nephritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/treatment-patterns-differ-based-on-age-of-systemic-lupus-erythematosus-onset-a-comparison-of-azathioprine-and-mycophenolate-on-the-prevention-of-lupus-nephritis/. Accessed February 18, 2020.
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