de Luca Montes, Ricardo Azedo and Huq, Molla and Godfrey, Timothy and Oon, Shereen and Calderone, Alicia and Kandane-Rathnayake, Rangi and Louthrenoo, Worawit and Luo, Shue Fen and Jan Wu, Yeong Jian and Golder, Vera and Lateef, Aisha and Navarra, Sandra V. and Zamora, Leonid and Hamijoyo, Laniyati and Sockalingam, Sargunan and An, Yuan and Li, Zhanguo and Katsumata, Yasuhiro and Harigai, Masayoshi and Chan, Madelynn and Goldblatt, Fiona and O'Neill, Sean and Lau, Chak Sing and Cho, Jiacai and Hoi, Alberta and Karyekar, Chetan S. and Morand, Eric F. and Nikpour, Mandana (2024) Association of systemic lupus erythematosus standard of care immunosuppressants with glucocorticoid use and disease outcomes: a multicentre cohort study. Advances in Rheumatology, 64 (1). p. 38. ISSN 2523-3106, DOI https://doi.org/10.1186/s42358-024-00366-y.
Full text not available from this repository.Abstract
Background This study examines the association of standard-of-care systemic lupus erythematosus (SLE) medications with key outcomes such as low disease activity attainment, flares, damage accrual, and steroid-sparing, for which there is current paucity of data. Methods The Asia Pacific Lupus Collaboration (APLC) prospectively collects data across numerous sites regarding demographic and disease characteristics, medication use, and lupus outcomes. Using propensity score methods and panel logistic regression models, we determined the association between lupus medications and outcomes. Results Among 1707 patients followed over 12,689 visits for a median of 2.19 years, 1332 (78.03%) patients achieved the Lupus Low Disease Activity State (LLDAS), 976 (57.18%) experienced flares, and on most visits patients were taking an anti-malarial (69.86%) or immunosuppressive drug (76.37%). Prednisolone, hydroxychloroquine and azathioprine were utilised with similar frequency across all organ domains; methotrexate for musculoskeletal activity. There were differences in medication utilisation between countries, with hydroxychloroquine less frequently, and calcineurin inhibitors more frequently, used in Japan. More patients taking leflunomide, methotrexate, chloroquine/hydroxychloroquine, azathioprine, and mycophenolate mofetil/mycophenolic acid were taking <= 7.5 mg/day of prednisolone (compared to > 7.5 mg/day) suggesting a steroid-sparing effect. Patients taking tacrolimus were more likely (Odds Ratio 95% Confidence Interval] 13.58 2.23-82.78], p = 0.005) to attain LLDAS. Patients taking azathioprine (OR 0.67 0.53-0.86], p = 0.001) and methotrexate (OR 0.68 0.47-0.98], p = 0.038) were less likely to attain LLDAS. Patients taking mycophenolate mofetil were less likely to experience a flare (OR 0.79 0.64-0.97], p = 0.025). None of the drugs was associated with a reduction in damage accrual. Conclusions This study suggests a steroid-sparing benefit for most commonly used standard of care immunosuppressants used in SLE treatment, some of which were associated with an increased likelihood of attaining LLDAS, or reduced incidence of flares. It also highlights the unmet need for effective treatments in lupus.
| Item Type: | Article |
|---|---|
| Funders: | National Health & Medical Research Council (NHMRC) of Australia |
| Uncontrolled Keywords: | Anti-malarials; Autoimmune diseases; Cohort study; Immunosuppressants; Systemic lupus erythematosus; SLEDAI |
| Subjects: | R Medicine |
| Divisions: | Faculty of Medicine |
| Depositing User: | Ms. Juhaida Abd Rahim |
| Date Deposited: | 19 Sep 2024 02:28 |
| Last Modified: | 19 Sep 2024 02:28 |
| URI: | http://eprints.um.edu.my/id/eprint/45245 |
Actions (login required)
 |
View Item |
