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EULAR 2017 | Daily Highlights
PREDICTORS OF PERSISTENT DISEASE ACTIVITY AND PERSISTENT LONG QUIESCENCE IN SYSTEMIC LUPUS ERYTHEMATOSUS – RESULTS FROM THE HOPKINS LUPUS COHORTAbstract: OP0045
Authors: I. Giannakou1,*, K. Chatzidionysiou1, L. Magder2, R. van Vollenhoven1, M. Petri3
1ClinTRID - Unit for Clinical Therapy Research, Inflammatory Diseases, Department of Medicine, Karolinska Institutet, Stockholm, Sweden, 2University of Maryland School of Medicine, 3Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, United States
Systemic lupus erythematosus (SLE) is characterized by a diversity of disease activity.
The aim of this study was to identify prognostic factors of persistent disease activity and persistent long quiescence using baseline demographics and clinical characteristics.
Patients enrolled in the Hopkins Lupus Cohort from 1987 to 2014, who had at least 3 visits per year during 3 years following cohort inclusion and available information on disease activity were included. Three major patterns of SLE disease activity over time (1 year intervals) based on the modified SLE Disease Activity Index have been previously described: long quiescent (LQ), chronic active (CA) and relapsing-remitting (RR) (1). Based on maintenance of the aforementioned patterns over 3 consecutive years, patterns have been defined as: Persistent Long Quiescent (pLQ), Persistent Relapsing-Remitting (pRR), Persistent Chronic Active (pCA) and Mixed, at least 2 different pattern types. Predictors of pCA (vs. pLQ, pRR and mixed) and pLQ (vs. pCA, pRR and mixed) were identified by univariate and multivariate logistic regression analyses. Several baseline demographics (age, sex, ethnicity, disease duration, tobacco use, years of education and combined annual family income), disease characteristics at baseline (SLEDAI, PGA) and treatment categories (hydroxychloroquine, prednisolone and cytotoxic treatment followed at ≥ 75% of visits vs <e;75% of visits) were used as independent variables.
916 patients were identified. The results of the univariate analyses for pCA are shown in table 1. In the multivariate model, African American ethnicity (OR: 2.43, 95%CI: 1.19-4.94, p: 0.01) and high baseline SLEDAI (OR: 1.09, 95%CI: 1.03-1.16, p: 0.004) remained significant predictors of pCA. Higher education (>12 years; OR. 2.16, 95%CI: 1.11-4.20, p: 0.02) and low baseline SLEDAI (OR: 0.62, 95%CI: 0.52-0.75, p:<e;0.001) were significant predictors of pLQ in the multivariate analysis while African American ethnicity (OR: 0.36, 95%CI: 0.16-0.78, p:0.01) and female patients (OR: 0.26, 95%CI: 0.12-0.56, p:0.001) were less likely to achieve persistent long quiescence.
In this large SLE cohort, African American ethnicity and high disease activity at the time of diagnosis are predictors of chronic activity, regardless of treatment, even after adjustment for education years and income, while higher education and low disease activity at baseline predict long-term quiescence.
1. Györi N, et al. Disease activity patterns over time in patients with systemic lupus erythematosus – Analysis of the Hopkins Lupus Cohort . Lupus Sci Med. 2017. In press.
Disclosure of Interest:
In clinical practice, it would be extremely helpful to know right from disease onset, which patients are prone to persistent high disease activity and damage and would thus deserve more intense treatment and follow up. In diseases such as RA, this has already been moved forward, and treatment guidelines suggest e.g. earlier treatment in RF and anti-CCP antibodies positive patients. In SLE, such predictive factors are less clear. This single center post hoc analysis of the Hopkins Lupus Cohort identified high disease activity at baseline and African ethnicity as risk factors for persistent high disease activity. Vice versa, low disease activity at baseline (and higher education in this US cohort) was predictive of persistent low disease activity. This has important implications for clinical practice. Patients with high disease activity at baseline should receive close follow up visits, to control for persistent disease activity despite therapy. Further studies have to address if these patients also may deserve more intense initial therapy and whether this leads to better control of long-term disease activity. The study has some technical limitations: First, it should be confirmed in an independent (non-US) cohort. Second, the number of parameters put into the logistic regression was high, which might lead to overfitting of the prediction model. Third, many of the prediction parameters showed moderate Odds ratios indicating that additional, yet unidentified factors might play a role in predicting persistent disease activity.
Prof. Dr. Oliver Distler