Studies Highlight Risk of Damage from Lupus Treatments

When these items were grouped together, 15.9% of all damage that occurred during the first two years was found to be associated with GCs, a figure that rose to 36.8% in Year 10. The annual incidence rate of items definitely related to GCs was 3.1% in the first two years and 3.7% in Year 10.

Ms. Little emphasized the importance of recognizing that the annual incidence rate of damage related to steroids is almost the same in the first two years as it is in Year 10. This shows “that steroid-related damage can occur early,” she said.

Because of this, Ms. Little concluded that “early introduction of GC-sparing strategies is essential to minimize the risk of short- and long-term damage in SLE.”

Mortality Trends

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Several presentations reported on mortality trends in SLE patients. April Jorge, MD, Department of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, presented the results of a large population-based matched cohort study that looked at the changes in mortality trends over recent years among SLE patients.²

Using data from the medical record database of the Health Improvement Network in the U.K, Dr. Jorge and colleagues identified cases of SLE and up to 10 controls matched on age, sex and entry time and compared mortality rates between an early cohort (1999–2006) of SLE patients (n=1,470) and controls (n=7,348) and a late cohort (2007–2014) of SLE patients (n=1,666) and controls (n=8,318).

With a mean follow-up time of 3.3 years, the study found that SLE patients had a higher risk of mortality compared with controls in both the early cohort (15.9 deaths vs. 7.9 deaths/1,000 person-years) and late cohort (31.8 vs. 7.0 deaths/1,000 person-years), with a hazard ratio of 2.15 (95% CI, 3.5–10.0) and 2.12 (95% CI, 1.61–2.80), respectively. The corresponding absolute mortality rate differences were 8.1 (95% CI, 1.3–11.8) deaths/1,000 person-years in the early cohort, and 6.9 (95% CI, 3.5–10.0) deaths/1,000 person-years in the late cohort.

The similar hazard ratios and absolute mortality rate differences found, after adjusting for age, sex and entry time, suggest similar levels of excess mortality in SLE patients in the two cohorts, said Dr. Jorge.

The study shows that “excess mortality for lupus patients has not improved relative to matched controls over the recent 16-year period,” Dr. Jorge said. This finding is in contrast to the substantial improvement in survival seen for other autoimmune diseases during the same time period.