Persistent Disease Activity Remains a Burden for Patients with Systemic Lupus Erythematosus

Christine A Peschken; Yishu Wang; Michal Abrahamowicz; Janet Pope; Earl Silverman; Amyn Sayani; Sandra Iczkovitz; Jorge Ross; Michel Zummer; Lori Tucker; Christian Pineau; Deborah Levy; Marie Hudson; Carol A Hitchon; Adam M Huber; C Douglas Smith; Antonio Avina-Zubieta; Hector Arbillaga; Gaëlle Chédeville; Willy Wynant; Paul R Fortin; CaNIOS 1000 Faces Investigators

doi:10.3899/jrheum.171454

Persistent Disease Activity Remains a Burden for Patients with Systemic Lupus Erythematosus

J Rheumatol. 2019 Feb;46(2):166-175. doi: 10.3899/jrheum.171454. Epub 2018 Sep 15.

Authors

Christine A Peschken^{1

2}, Yishu Wang^{3

4}, Michal Abrahamowicz^{3

4}, Janet Pope^{3

4}, Earl Silverman^{3

4}, Amyn Sayani^{3

4}, Sandra Iczkovitz^{3

4}, Jorge Ross^{3

4}, Michel Zummer^{3

4}, Lori Tucker^{3

4}, Christian Pineau^{3

4}, Deborah Levy^{3

4}, Marie Hudson^{3

4}, Carol A Hitchon^{3

4}, Adam M Huber^{3

4}, C Douglas Smith^{3

4}, Antonio Avina-Zubieta^{3

4}, Hector Arbillaga^{3

4}, Gaëlle Chédeville^{3

4}, Willy Wynant^{3

4}, Paul R Fortin^{3

4}; CaNIOS 1000 Faces Investigators

Affiliations

¹ From the Departments of Internal Medicine and Community Health Sciences, University of Manitoba, Winnipeg; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec; University of Western Ontario and St. Joseph's Health Care London, London; Hospital for Sick Children, Toronto; University of Toronto, Toronto; Medical Affairs, GlaxoSmithKline Inc., Mississauga, Ontario; CH Maisonneuve-Rosemont, Montreal; BC Children's Hospital, Vancouver, British Columbia; McGill University Health Centre, Montreal, Quebec; Jewish General Hospital, Lady Davis Institute and McGill University, Montreal, Quebec; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; University of Ottawa, Ottawa, Ontario; Division of Rheumatology, Arthritis Research Canada, University of British Columbia; Rheumatology Clinic, Calgary, Alberta; Montreal Children's Hospital, McGill University Health Centre, Montreal; Division of Rheumatology, Department of Medicine, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; GlaxoSmithKline Inc., King of Prussia, Pennsylvania, USA. [email protected].
² C.A. Peschken, MD, MSc, FRCPC, Departments of Internal Medicine, and Community Health, University of Manitoba; Y. Wang, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J. Pope, MD, University of Western Ontario and St. Joseph's Health Care London; E. Silverman, MD, Hospital for Sick Children, and University of Toronto; A. Sayani, PhD, Medical Affairs, GlaxoSmithKline Inc., Mississauga; S. Iczkovitz, BSc, Medical Affairs, GlaxoSmithKline Inc., Mississauga; J. Ross, MD, GlaxoSmithKline Inc., King of Prussia; M. Zummer, MD, CH Maisonneuve-Rosemont; L. Tucker, MD, BC Children's Hospital; C. Pineau, MD, McGill University Health Centre; D. Levy, MD, Hospital for Sick Children, and University of Toronto; M. Hudson, MD, Jewish General Hospital, Lady Davis Institute and McGill University; C.A. Hitchon, MD, MSc, Department of Internal Medicine, University of Manitoba; A.M. Huber, MD, MSc, IWK Health Centre and Dalhousie University; C.D. Smith, MD, University of Ottawa; A. Avina-Zubieta, MD, PhD, Division of Rheumatology, Arthritis Research Canada, University of British Columbia; H. Arbillaga, MD, Rheumatology Clinic, Calgary; G. Chédeville, MD, Montreal Children's Hospital, McGill University Health Centre; W. Wynant, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; P.R. Fortin, MD, MPH, Division of Rheumatology, Department of Medicine, CHU de Québec-Université Laval. [email protected].
³ From the Departments of Internal Medicine and Community Health Sciences, University of Manitoba, Winnipeg; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec; University of Western Ontario and St. Joseph's Health Care London, London; Hospital for Sick Children, Toronto; University of Toronto, Toronto; Medical Affairs, GlaxoSmithKline Inc., Mississauga, Ontario; CH Maisonneuve-Rosemont, Montreal; BC Children's Hospital, Vancouver, British Columbia; McGill University Health Centre, Montreal, Quebec; Jewish General Hospital, Lady Davis Institute and McGill University, Montreal, Quebec; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; University of Ottawa, Ottawa, Ontario; Division of Rheumatology, Arthritis Research Canada, University of British Columbia; Rheumatology Clinic, Calgary, Alberta; Montreal Children's Hospital, McGill University Health Centre, Montreal; Division of Rheumatology, Department of Medicine, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; GlaxoSmithKline Inc., King of Prussia, Pennsylvania, USA.
⁴ C.A. Peschken, MD, MSc, FRCPC, Departments of Internal Medicine, and Community Health, University of Manitoba; Y. Wang, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J. Pope, MD, University of Western Ontario and St. Joseph's Health Care London; E. Silverman, MD, Hospital for Sick Children, and University of Toronto; A. Sayani, PhD, Medical Affairs, GlaxoSmithKline Inc., Mississauga; S. Iczkovitz, BSc, Medical Affairs, GlaxoSmithKline Inc., Mississauga; J. Ross, MD, GlaxoSmithKline Inc., King of Prussia; M. Zummer, MD, CH Maisonneuve-Rosemont; L. Tucker, MD, BC Children's Hospital; C. Pineau, MD, McGill University Health Centre; D. Levy, MD, Hospital for Sick Children, and University of Toronto; M. Hudson, MD, Jewish General Hospital, Lady Davis Institute and McGill University; C.A. Hitchon, MD, MSc, Department of Internal Medicine, University of Manitoba; A.M. Huber, MD, MSc, IWK Health Centre and Dalhousie University; C.D. Smith, MD, University of Ottawa; A. Avina-Zubieta, MD, PhD, Division of Rheumatology, Arthritis Research Canada, University of British Columbia; H. Arbillaga, MD, Rheumatology Clinic, Calgary; G. Chédeville, MD, Montreal Children's Hospital, McGill University Health Centre; W. Wynant, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; P.R. Fortin, MD, MPH, Division of Rheumatology, Department of Medicine, CHU de Québec-Université Laval.

PMID: 30219771
DOI: 10.3899/jrheum.171454

Abstract

Objective: Persistent systemic lupus erythematosus (SLE) disease activity is associated with increased morbidity and mortality. In a multicenter cohort of patients with prevalent SLE, we described persistence, patterns, and predictors of change in disease activity over time.

Methods: Based on SLE Disease Activity Index (SLEDAI)-2K scores at cohort entry, patients were classified into 4 groups: low (score < 4; LOW), moderate (4 to < 6; MOD), moderately high (6 to ≤ 10; MHIGH), and very high (> 10; VHIGH). Multivariable linear and longitudinal mixed linear regression models were used to identify predictors of change over time in SLEDAI-2K.

Results: There were 2019 participants, with declining followup data over 5 years (1326, 580, 274, 186, and 148 patients, respectively). At cohort entry, mean (± SD) age was 42 (± 17) years, disease duration 11 (± 10) years, and 90% were female. The 4 groups included 44% LOW (n = 891), 20% MOD (n = 400), 22% MHIGH (n = 442), and 14% VHIGH (n = 286); therefore, 36% had clinically important SLE activity. The proportion of patients in the LOW group at entry who moved to a higher activity level varied from 30% (167/557) at 1 year, to 49% (41/83) at 3 years, and 54% (30/56) at 5 years. Among 181 patients with MOD to VHIGH entry activity and 3 years of followup, 116 (64.1%) remained active. In all analyses, only higher SLEDAI-2K at cohort entry remained a significant predictor of higher SLEDAI-2K in subsequent years.

Conclusion: Higher SLEDAI-2K at study entry was the single major independent predictor of higher SLEDAI-2K over time, reflecting frequent persistence of active disease, even in patients with longstanding disease. This highlights gaps in the optimal treatment of SLE.

Keywords: DISEASE ACTIVITY; SYSTEMIC LUPUS ERYTHEMATOSUS.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Canada / epidemiology
Cross-Sectional Studies
Disease Progression*
Female
Follow-Up Studies
Humans
Linear Models
Lupus Erythematosus, Systemic / drug therapy
Lupus Erythematosus, Systemic / epidemiology*
Lupus Erythematosus, Systemic / mortality
Lupus Erythematosus, Systemic / physiopathology*
Male
Middle Aged
Prednisone / therapeutic use
Prevalence
Prognosis
Prospective Studies
Severity of Illness Index*
Young Adult

Substances

Prednisone