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Lupus patients experienced bouts of active disease during follow-up
Sixty-six percent of patients with systemic lupus erythematosus had at least one period of active disease during a 7-year follow-up despite stringent monitoring and standard therapy, according to study results.
Researchers in Italy evaluated 165 patients (mean age, 37.5 years; 87.3% women) registered in a lupus database who were diagnosed with systemic lupus erythematosus (SLE) between 1991 and 2004 and were followed up quarterly from 2004 to 2010. SLE Disease Activity Index-2000 (SLEDAI-2K), excluding serology, was used to define disease activity. The SELENA-SLEDAI-2K flare index was used to define flare as an increase in SLEDAI-2K≥4 from the previous visit.
One hundred nine (66%) patients had at least one period of active disease (chronic active disease [CAD], relapsing-remitting disease [RRD] and minimal disease activity [MDA]), and 56 patients (34%) experienced persistent clinical quiescent disease (CQD) during follow-up. In each disease pattern, mean number of patients per year was 87 (52.6%) for CQD, 52.4 (31.7%) for CAD, 16.1 (9.7%) for RRD and 9.7 (5.9%) for MDA.
One hundred two patients (61.8%) had one or more lupus flares during follow-up. Annual incidence of any flares was 0.19 per patient/year (mild flares=0.10 per patient/year; severe flares=0.09 per patient/year). Patients with CAD had a higher mean number of flares compared with those with RRD (P<.01).
Using multivariate analysis, “positive anti-dsDNA antibodies, low C3 or C4, male sex, long lag time between SLE onset and diagnosis, higher number of flares, and use of immunosuppressant were independently associated with active disease including CAD and RRD patterns,” the researchers reported.
“Two-thirds of patients experienced at least one period of CAD, RRD or MDA during the entire follow-up, despite a tight monitoring and a standard treatment,” the researchers concluded. “Thus, the identification of new predictive biomarkers and the development of new molecules are still needed in order to abrogate disease activity and decrease recurrences, increasing disease survival and quality of the life of SLE patients.”