勝又 康弘
   Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine
   Position   Assistant Professor
Article types Original article
Language English
Peer review Peer reviewed
Title 'Not at target': prevalence and consequences of inadequate disease control in systemic lupus erythematosus-a multinational observational cohort study.
Journal Formal name:Arthritis research & therapy
Abbreviation:Arthritis Res Ther
ISSN code:14786362/14786354
Domestic / ForeginForegin
Volume, Issue, Page 24(1),pp.70
Author and coauthor Kandane-Rathnayake Rangi, Louthrenoo Worawit, Hoi Alberta, Luo Shue-Fen, Wu Yeong-Jian J, Chen Yi-Hsing, Cho Jiacai, Lateef Aisha, Hamijoyo Laniyati, Navarra Sandra V, Zamora Leonid, Sockalingam Sargunan, An Yuan, Li Zhanguo, Katsumata Yasuhiro, Harigai Masayoshi, Hao Yanjie, Zhang Zhuoli, Kikuchi Jun, Takeuchi Tsutomu, Basnayake B M D B, Chan Madelynn, Ng Kristine Pek Ling, Tugnet Nicola, Kumar Sunil, Oon Shereen, Goldblatt Fiona, O'Neill Sean, Gibson Kathryn A, Ohkubo Naoaki, Tanaka Yoshiya, Bae Sang-Cheol, Lau Chak Sing, Nikpour Mandana, Golder Vera, Morand Eric F,
Publication date 2022/03
Summary 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.
DOI 10.1186/s13075-022-02756-3
PMID 35287720