Association of systemic lupus erythematosus standard of care immunosuppressants with glucocorticoid use and disease outcomes: a multicentre cohort study

de Luca Montes RA 1 , Huq M 2 , Godfrey T 3 , Oon S 2 , Calderone A 3 , Kandane-Rathnayake R 4 Show all authors , Louthrenoo W 5 , Luo SF 6 , Jan Wu YJ 7 , Golder V 4 , Lateef A 8 , Navarra SV 9 , Zamora L 9 , Hamijoyo L 10 , Sockalingam S 11 , An Y 12 , Li Z 12 , Katsumata Y 13 , Harigai M 14 , Chan M 15 , Goldblatt F 16 , O'Neill S 17 , Lau CS 18 , Cho J 8 , Hoi A 4 , Karyekar CS 19 , Morand EF 4 , Nikpour M 20

Affiliations 

  • 1 Rheumatology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
  • 2 Department of Medicine, The University of Melbourne at St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
  • 3 Department of Rheumatology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
  • 4 Monash University, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
  • 5 Chiang Mai University Hospital, 110 Intravororos Street, Muang District, Chang Mai, 50200, Thailand
  • 6 Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan Township, Taoyuan County, 333, Taiwan
  • 7 Chang Gung Memorial Hospital, 222, Maijin Road, Anle District, Keelung City, 204, Taiwan
  • 8 National University Hospital, 1E Kent Ridge Road, #13-00, Singapore, Singapore
  • 9 University of Santo Tomas Hospital, España Boulevard, Sampaloc, Manila, Philippines
  • 10 University of Padjadjaran, JI Pasteur 38, Bandung West, Jawa Barat, Indonesia
  • 11 University of Malaya, Wilayah Persekutuan Kuala Lumpur, 50603, Malaysia
  • 12 People's Hospital Peking University Health Sciences Centre, 11 Xizhimen South Street, Western District, Beijing, 100044, China
  • 13 Tokyo Women's Medical University, 10-22 Kawada-Cho, Shinjuku, Tokyo, 162-0054, Japan
  • 14 Rheumatology, Tokyo Women's Medical University, 10-22 Kawada-Cho, Shinjuku, Tokyo, 162-0054, Japan
  • 15 Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
  • 16 Department of Rheumatology, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
  • 17 University of New South Wales and Ingham Institute of Applied Medical Research, 1 Campbell St, Liverpool, New South Wales, 2170, Australia
  • 18 University of Hong Kong, Queen Mary Hospital, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong
  • 19 Janssen Pharmaceutical Companies of Johnson and Johnson, 1125 Trenton Harbourton Rd, Titusville, NJ, 08560, USA
  • 20 Department of Medicine, The University of Melbourne at St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia. [email protected]
Adv Rheumatol, 2024 May 08;64(1):38.
PMID: 38720354 DOI: 10.1186/s42358-024-00366-y

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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