`Not at target': Prevalence and consequences of inadequate disease control in systemic lupus erythematosus-a multinational observational cohort study

Kandane-Rathnayake, Rangi and Louthrenoo, Worawit and Hoi, Alberta and Luo, Shue-Fen and Wu, Yeong-Jian J. and Chen, Yi-Hsing and Cho, Jiacai and Lateef, Aisha and Hamijoyo, Laniyati and Navarra, Sandra and Zamora, Leonid and Sockalingam, Sargunan and An, Yuan and Li, Zhanguo and Katsumata, Yasuhiro and Harigai, Masayoshi and Hao, Yanjie and Zhang, Zhuoli and Kikuchi, Jun and Takeuchi, Tsutomu and Basnayake, B. M. D. B. and Chan, Madelynn and Ng, Kristine Pek Ling and Tugnet, Nicola and Kumar, Sunil and Oon, Shereen and Goldblatt, Fiona and O'Neill, Sean and Gibson, Kathryn A. and Ohkubo, Naoaki and Tanaka, Yoshiya and Bae, Sang-Cheol and Lau, Chak Sing and Nikpour, Mandana and Golder, Vera and Morand, Eric F. and Collaboration, Asia-Pacific Lupus (2022) `Not at target': Prevalence and consequences of inadequate disease control in systemic lupus erythematosus-a multinational observational cohort study. Arthritis Research & Therapy, 24 (1). ISSN 1478-6354, DOI https://doi.org/10.1186/s13075-022-02756-3.

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Background The unmet need in systemic lupus erythematosus (SLE) with the current standard of care is widely recognised, but few studies have quantified this. The recent definition of treat-to-target endpoints and other thresholds of uncontrolled disease activity provide an opportunity to formally define unmet need in SLE. In this study, we enumerated the prevalence of these states and examined their association with adverse outcomes. Methods Data were collected prospectively in a 13-country longitudinal SLE cohort between 2013 and 2019. Unmet need was defined as never attaining lupus low disease activity state (LLDAS), a time-adjusted mean SLEDAI-2K (AMS) > 4, or ever experiencing high disease activity status (HDAS; SLEDAI-2K >= 10). Health-related quality of life (HRQoL) was assessed using SF36 (v2) and damage accrual using the SLICC-ACR SLE Damage Index (SDI). Results A total of 3384 SLE patients were followed over 30,313 visits (median IQR] follow-up 2.4 0.4, 4.3] years). Eight hundred thirteen patients (24%) never achieved LLDAS. Median AMS was 3.0 1.4, 4.9]; 34% of patients had AMS > 4. Twenty-five per cent of patients had episodes of HDAS. Each of LLDAS-never, AMS>4, and HDAS-ever was strongly associated with damage accrual, higher glucocorticoid use, and worse HRQoL. Mortality was significantly increased in LLDAS-never (adjusted HR 95% CI] = 4.98 2.07, 12.0], p<0.001) and HDAS-ever (adjusted hazard ratio (HR) 95% CI] = 5.45 2.75, 10.8], p<0.001) patients. Conclusion Failure to achieve LLDAS, high average disease activity, and episodes of HDAS were prevalent in SLE and were significantly associated with poor outcomes including organ damage, glucocorticoid exposure, poor quality of life, and mortality.

Item Type: Article
Funders: Eli Lilly, Janssen Biotech Inc, Merck & Company, UCB Pharma SA, GlaxoSmithKline
Uncontrolled Keywords: Systemic lupus erythematosus; Disease activity; Outcomes; Quality of life; Unmet need
Subjects: R Medicine > RC Internal medicine
Divisions: Faculty of Medicine > Medicine Department
Depositing User: Ms. Juhaida Abd Rahim
Date Deposited: 10 Aug 2022 03:00
Last Modified: 10 Aug 2022 03:00
URI: http://eprints.um.edu.my/id/eprint/32744

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