Poor Outcomes in Lupus Patients Not at Target Save

A prospective, longitudinal systemic lupus erythematosus (SLE) cohort study examined outcomes and showed that failure to control SLE was common and associated with poorer outcomes including organ damage, glucocorticoid exposure, poor quality of life, and increased mortality.

Data were collected prospectively from a multinational longitudinal SLE cohort between 2013 and 2019. Outcomes included never attaining lupus low disease activity state (LLDAS), SLEDAI-2K (AMS) > 4, high disease activity status (HDAS; SLEDAI-2K ≥10), . Health-related quality of life (HRQoL - SF36) and damage accrual using the SLICC-ACR SLE Damage Index (SDI).

The cohort included 3384 SLE patients followed for a median of 2.4 [0.4, 4.3] years.  Poor outcomes where not uncommon:

• LLDAS never achieved in 24%
• Active SLEDAI-2K > 4 was seen in 34%
• High disease activity (SLEDAI-2K > 10) was seen in 25%

These three measures of poor control (LLDAS, active SLE, high disease activity) was was strongly associated with high organ damage accrual, higher glucocorticoid use, and worse HRQoL.

Mortality was significantly increased in LLDAS-never patients (adjusted HR = 4.98) and in HDAS-ever (adjusted HR = 5.45) patients.

This "poor control" subset of SLE patients is unexpectedly large (25%-34%) and is clearly linked to organ damage, mortality and poor quality of life.