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Organ damage in patients with SLE linked to disease activity, glucocorticoids
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Multiple factors influence organ damage in patients with systemic lupus erythematosus, but researchers found disease activity and the use of glucocorticoids were likely strong influencers, according to data from the Hopkins Lupus Cohort.
A total of 2,199 patients with systemic lupus erythematosus (SLE) from the cohort, which included 2,265 patients followed for more than 26 years between 1987 and October 2012, were studied. Cox proportional hazards models were used to study the relationships between irreversible organ damage, such as cataracts, osteoporotic fractures and cardiovascular and renal damage; disease activity and treatment types; and duration since entry into the cohort.
Mean patient age was 38 years; 92.5% of the patients were women, 29.2% entered the cohort in the first year after diagnosis and 42.9% entered the cohort in their second year after diagnosis. Mean disease duration was 5.1 years. More than half (55.3%) of the patients were white and 37.5% were black.
Immunosuppressants were used by 19.2% of patients, whereas 70.3% of patients received hydroxychloroquine, 52.7% received corticosteroids and some patients used more than one therapy. Slightly more than 40% of patients received an average daily dose of prednisone of 7.5 mg or more.
Baseline patient data gathered included the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), Physician Global Assessment (PGA), Lupus Activity Index (LAI) and Safety of Estrogens in Lupus Erythematosus National Assessment version of the SLE Disease Activity Index (SELENA-SLEDAI), in addition to other laboratory tests.
The most common types of new organ damage observed in the cohort included musculoskeletal damage in 20.3% of patients, ocular damage in 15.8%, cataracts in 13.7% and osteoporotic fractures in 12.4%.
Cox proportional hazards models revealed that age and SDI score at cohort entry, mean prednisone dose during follow-up, year of diagnosis, mean SELENA-SLEDAI scores and use of immunosuppressants during follow-up were predictive of new organ damage, according to the researchers.
Patients who received an average of 7.5 mg or more per day of prednisone were 1.742-times more likely to develop new organ damage than those on lower average dosages, and the risk increased in a linear direction as the dosage increased. Patients who received 20 mg per day or more of prednisone were more than twice as likely to develop new organ damage. The risk of developing new organ damage increased by 3% with each 1 mg increase in average daily prednisone exposure, according to the researchers. - by Shirley Pulawski
Disclosure: Sawah is an employee and stockholder in Eli Lilly and Company. Please see the full study for a list of all other authors’ relevant financial disclosures.
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