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Earlier treatment, new medications improved outcomes in patients with SLE
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Patients with systemic lupus erythematosus had earlier referrals and diagnoses, along with better outcomes, in the 2000s than patients in the 1990s, according to findings from a study.
Using data from the German Collaborative Arthritis Centres — an ongoing, prospective study established in 1993 as a long-term monitoring system for rheumatology patients in Germany — researchers identified 467 patients with 4 years of follow-up between the years 1994 and 1998, and 376 patients with follow-up data from 2004 to 2008.
Cross-sectional data on drug treatment, patient- and physician-reported assessments, health care use and work participation from 1993 to 2012 were compared. The researchers also collected information about the frequency and duration of sick leave and hospital stays and duration.
Between 1993 and 2012, the number of patients who met criteria for systemic lupus erythematosus (SLE) and analysis ranged from 850 to 1,300 per year. Median age of patients was 42 years in 1993 and 45 years in 2012; 89% were women. Mean disease duration was 11 years in 1993 and 15 years in 2012.
In 1993, mild disease was reported in 45% of patients, 41% had moderate disease and 14% had severe or very severe disease activity. In 2012, the number of patients with severe or very severe disease declined by 3%, according to the researchers.
The percentage of patients who met with a rheumatologist within 6 months of symptom onset increased from 63% to 76% between 1993 and 2008. Mean disease duration at the time of the first visit with a rheumatologist decreased from 2.6 years in 1994 to 1.5 years in 2012.
The use of antimalarial drugs increased from 36% in 1993 to 56% in 2012. Use of azathioprine and cyclosporine declined in the observed time period. Since 2005, mycophenenolate mofetil has been prescribed, and in 2012, the rate of prescription rose to 15%.
Approximately 7% of patients received methotrexate, and approximately 3% of patients were prescribed cyclophosphamide. In 2012, 4% of patients were prescribed biologics. Only 10% of patients received glucocorticoids in 2012 vs. 27% in 1996.
The number of patients with low disease activity increased from 69% in 1993 to 88% in 2012. Mean patient assessment of pain on an 11-point scale decreased from 3.3 to 2.8, showing less pain severity, and patients reporting severe pain dropped from 17% in 1993 to 13% in 2012. Global health remained unchanged, but patients with poor global health decreased, and patients reporting good functioning increased by 10%, according to the researchers.
Disclosure: The authors have no relevant financial disclosures.
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