Methylprednisolone exposure a significant risk factor for organ damage in pediatric lupus
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Reducing steroids in favor of more targeted therapies can minimize organ damage in pediatric systemic lupus erythematosus, according to data presented at EULAR 2024 Congress.
“As a pediatric rheumatologist, I am really grateful that EULAR has children with rheumatic diseases in its focus,” Dirk Foell, MD, president of the EULAR Pediatric Rheumatology Committee, and head of the department of pediatric rheumatology and immunology at the University of Muenster, in Germany, told attendees at a press conference during the meeting. “Systemic lupus in children is not easy to diagnose and not easy to treat.”
In the current analysis, Maria Hanif, of the Institute of Life Course and Medical Sciences, at the University of Liverpool, and colleagues aimed to assess how clinical, demographic and treatment variables correlate with damage accrual in SLE among patients aged 18 years or younger.
“There are now recommendations for treatment to target,” Foell said. “There are better targets to treat.”
The researchers analyzed 4,738 visits among 430 patients enrolled in the UK JSLE Cohort Study with a median follow-up period of 46 months (interquartile range, 18-63). In all, they assessed a median number of 10 visits per patient (IQR, 5-15).
Results showed that 23% of the cohort experienced organ damage during follow-up.
According to the researchers, the multivariable analysis revealed a number of factors associated with damage accrual, including methylprednisolone exposure (HR = 2.2; P = .002), time-adjusted mean physicians’ global assessment (PGA) score (HR = 2.87; P = .002), and adjusted mean Systemic Lupus Erythematosus Disease Activity Index-2K (AMS) score (HR = 1.13; P = .013).
“They found, not surprisingly, that in those with higher disease activity, you have a higher proportion of children with organ damage,” Foell said.
In addition, an analysis of patients with low disease activity revealed that 20.5% of this group accrued new damage during follow-up. Multivariable analysis of this group demonstrated several factors associated with damage accrual, including methylprednisolone exposure (HR = 2.61; P = .04) and time-adjusted mean PGA score (HR = 3.41; P = .003).
In the moderate/high disease activity subgroup, damage associated with methylprednisolone exposure was observed in 28.1% (HR =2.29; 95% CI, 1.31-4) of patients.
“Use of corticosteroids was obviously associated with the generation of organ damage,” Foell said.
Other significant factors associated with damage accrual over time in the moderate/high disease activity group included time-adjusted mean PGA score (HR = 2.66; P = .016) and AMS score (HR = 1.15; P = .014).
“This is giving us as pediatric rheumatologists reason to believe that using treatment to target with more targeted therapies and reducing the dose of corticosteroids over the longer term will be better,” Foell said.
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Hanif M. OP0246. Presented at: EULAR 2024 Congress; June 12 to June 15, 2024, Vienna, Austria.
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