Researchers have identified a number of predictors of damage and/or death in patients with systemic lupus erythematosus.
Data from the inception cohort of 160 SLE patients show that predictors of new damage or death in this population include older age at diagnosis (odds ratio, 1.02), hypercholesterolemia (OR, 2.67), antiphospholipid syndrome (OR, 2.97), BILAG (British Isles Lupus Assessment Group)-2004 mucocutaneous grade A or B disease activity score (OR, 2.75), BILAG-2004 haematological grade A or B score (OR, 18.20), cumulative hydroxychloroquine (per gram) exposure (OR, 0.98), and cumulative mepacrine (per gram) exposure (OR, 1.96 × 10
Factors found not to be associated with damage or death were other BILAG-2004 system scores, sex, ethnicity, hypertension, smoking status, prior damage, and cumulative exposure to immunosuppressives/biologic therapies, Dr. Yee said at the annual European Congress of Rheumatology in London.
The investigators included only SLE patients from the multicenter study, which began in 2004, who achieved the fourth American College of Rheumatology criteria for an SLE diagnosis within 12 months at the time of recruitment. Patients had a mean age of 35 years, and the median follow-up was 39 months with a total follow-up of 497 patient years.
Two of the 160 patients died, and 35 instances of damage occurred in 30 patients.
Damage was musculoskeletal in 31% of cases; ophthalmic in 23% of cases; neuropsychiatric in 17% of cases; renal, vascular, or diabetes mellitus in 6% of cases each; and pulmonary, cardiac, cutaneous, or a malignancy in 3% of cases each.
The incident rates of development of damage across the follow-up period were 73, 86, 82, 42, 24, and 112 cases per 1,000 patient-years for follow-up years 1-6, respectively, and about 70 cases per 1,000 patient-years overall.
As demonstrated by these data, the development of damage starts in the first year and most commonly affects the musculoskeletal, ophthalmic, and neuropsychiatric systems. The rate at which damage occurs, however, is slower compared with that seen in previous studies, Dr. Yee said, noting that antimalarials appear to confer some protection against damage and death.
Findings from previous studies have shown that hydroxychloroquine provides such protection, so this was not a surprising finding. In the current study, though, there was only a 2% reduction in risk with hydroxychloroquine, Dr. Yee said.
“Mepacrine, however, was strongly protective in our study, and this was somewhat surprising,” he added, noting that the finding should be interpreted with caution pending confirmation in future studies.
Dr. Yee said this study is the only one of which he is aware to report on the development of damage from a well-characterized inception cohort of SLE patients who were followed-up prospectively.
“My results highlight the importance of managing cardiovascular risk factors and carefully monitoring patients with associated antiphospholipid syndrome,” he said, noting that there is a need for more interventional studies on SLE patient with associated antiphospholipid syndrome, as this group of patients is often excluded from clinical trials.
Dr. Yee disclosed that he has received grant and/or research support from Aspreva/Vifor Pharma, and has served as a consultant for Genentech, Parexel, and Teva.