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Thibault T, Rajillah A, Bourredjem A, Corneloup M, Maurier F, Wahl D, Muller G, Aumaitre O, Sève P, Blaison G, Besancenot JF, Martin T, Magy-Bertrand N, Samson M, Arnaud L, Amoura Z, Devilliers H. Health-related quality of life, remission and low lupus disease activity state in patients with systemic lupus erythematosus. Rheumatology (Oxford) 2024; 63:1447-1455. [PMID: 37589711 DOI: 10.1093/rheumatology/kead407] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/10/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES To measure the association between SLE remission and scores of patients-reported outcome (PRO) measures. METHODS We performed a prospective cohort study of SLE patients with a 2-year follow-up, using Lupus Patient-Reported Outcome (LupusPRO), Lupus Quality of Life (LupusQoL), Systemic Lupus Erythematosus Quality of Life (SLEQOL) and 36-item Short Form (SF-36) questionnaires. Remission was defined as remission off treatment (ROFT) and remission on treatment (RONT) according to the definitions of remission in SLE consensus. Mixed models accounting for repeated measures were used to compare groups as follow: ROFT and RONT vs no remission and lupus low disease activity state (LLDAS) vs no LLDAS. RESULTS A total of 1478 medical visits and 2547 PRO questionnaires were collected during the follow-up from the 336 recruited patients. A between-group difference in PRO scores reaching at least 5 points on a 0-100 scale was obtained in the following domains: lupus symptoms (LLDAS: +5 points on the 0-100 scale, RONT: +9, ROFT: +5), lupus medication (LLDAS: +5, RONT: +8, ROFT: +9), pain vitality (LLDAS: +6, RONT: +9, ROFT: +6) of LupusPRO; role emotional (LLDAS: +5, RONT: +8), role physical (RONT: +7 and ROFT: +7), bodily pain (RONT: +6), mental health (RONT: +5) and social functioning (RONT: +6) of SF-36. In contrast, a between-group difference reaching at least 5 points was not achieved for any of the LupusQoL and SLEQOL domains. CONCLUSIONS RONT, ROFT and LLDAS were associated with significant and clinically relevant higher QoL in most PRO domains of the LupusPRO (disease specific) and SF-36 (generic) questionnaires, but not with LupusQoL and SLEQOL disease-specific questionnaires.
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Affiliation(s)
- Thomas Thibault
- Internal Medicine and Systemic Diseases Unit, University Hospital Dijon-Burgundy, Dijon, France
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon, France
| | - Abdessamad Rajillah
- Internal Medicine and Systemic Diseases Unit, University Hospital Dijon-Burgundy, Dijon, France
| | - Abderrahmane Bourredjem
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon, France
| | - Marie Corneloup
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon, France
| | - François Maurier
- Department of Internal Medicine and Clinical Immunology, Hôpital Robert Schuman, Metz-Vantoux, 57070, France
| | - Denis Wahl
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Inserm UMR_S 1116, CHRU de Nancy, University of Lorraine, Nancy, France
| | - Geraldine Muller
- Internal Medicine and Systemic Diseases Unit, University Hospital Dijon-Burgundy, Dijon, France
| | - Olivier Aumaitre
- Department of Internal Medicine, Centre Hospitalier Universitaire, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Pascal Sève
- Department of Internal Medicine, Lyon University Hospital, Hôpital Croix Rousse, Lyon, France
- Research on Healthcare Performance, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Gilles Blaison
- Department of Internal Medicine, Hôpital Louis Pasteur, Colmar, France
| | | | - Thierry Martin
- Internal Medicine and Clinical Immunology Department, Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest Strasbourg University Hospital, Strasbourg, France
| | - Nadine Magy-Bertrand
- Department of Internal Medicine, University Hospital Jean Minjoz, Besançon, France
| | - Maxime Samson
- Internal Medicine and Clinical Immunology Unit, University Hospital Dijon-Burgundy, Dijon, France
| | - Laurent Arnaud
- Department of Rheumatology, Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- INSERM UMR-S 1109, Strasbourg, France
| | - Zahir Amoura
- Department of Internal Medicine, National Referral Center for Systemic Lupus Erythematosus and Anti-Phospholipid Syndrome, Pitié-Salpêtrière University Hospital, Paris, France
| | - Hervé Devilliers
- Internal Medicine and Systemic Diseases Unit, University Hospital Dijon-Burgundy, Dijon, France
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon, France
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Arnaud L, Parodis I, Devilliers H, Chasset F. Clinical trial outcomes for SLE: what we have and what we need. Lupus Sci Med 2024; 11:e001114. [PMID: 38360028 PMCID: PMC10875561 DOI: 10.1136/lupus-2023-001114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/19/2024] [Indexed: 02/17/2024]
Abstract
The paradigm of drug approval in SLE currently relies on successful large phase III randomised controlled trials and a set of primary, secondary and additional end points. Taken together, these outcomes offer a nuanced understanding of the efficacy and safety of the investigational agent. In this review, we thoroughly examine the main outcomes used in SLE trials and highlight unmet requirements as well as potential venues for future trial design in SLE. Disease activity indices can be broadly categorised into global-specific and organ-specific indices, in particular for skin, joints and kidneys, but there is no universal consensus about their use in clinical trials. Because each of these instruments has its own intrinsic strengths and weaknesses, the assessment of treatment response has progressed from relying solely on one individual disease activity index to using composite responder definitions. Those are typically measured from the trial baseline to the end point assessment date and may be combined with the need to taper and maintain glucocorticoids (GCs) within prespecified ranges. Remission and low disease activity are two critical states in the perspective of 'Treat-to-Target' trials, but are not fully recognised by regulators. While significant progress has been made in clinical trial outcomes for SLE, there is a clear need for continued innovation. Addressing these challenges will require collaboration between researchers, clinicians, patients as well as with regulatory agencies to refine existing outcome measures, incorporate meaningful and ethnically diverse patient perspectives, foster relevant digital opportunities and explore new therapeutic avenues, including early use of investigational agents. By doing so, we can advance our ability to manage SLE effectively and safely and improve the lives of those living with this complex and impactful autoimmune disease.
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Affiliation(s)
- Laurent Arnaud
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Centre National de Référence Maladies Rares Est Sud-Ouest (RESO), Strasbourg, France
| | - Ioannis Parodis
- Service de rhumatologie, Institut Karolinska, Stockholm, Sweden
| | - Hervé Devilliers
- Servide de Médecine interne, CHU Dijon - Bourgogne, Hôpital F. MITTERRAND, Dijon, France
| | - Francois Chasset
- Sorbonne Université, Faculté de médecine, AP-HP, Service de Dermatologie et Allergologie, Hôpital Tenon, and INSERM U1135, Paris, France
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Wang YH, Sun HY, Liu YQ, Gong XY, Xu Y, Zong QQ, Yu GH, Hu WQ, Zhai CX, Wang LL, Yan ZY, Zhang TY, Cai J, Li M, Chen YF, Wang F, Zou YF. Health-related quality of life in Chinese SLE patients: evidence from 1568 SLE patients and 2610 healthy controls. Qual Life Res 2024; 33:207-218. [PMID: 37824058 DOI: 10.1007/s11136-023-03516-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To investigate the effects of systemic lupus erythematosus (SLE) on health-related quality of life (HRQOL), the relationship between disease activity and HRQOL, and potential factors affecting HRQOL in Chinese SLE patients. METHODS This study recruited 1568 patients and 2610 controls to explore the effects of SLE on HRQOL. The association between disease activity and HRQOL, and the influencing factors of HRQOL were determined in 1568 patients. Then, we prospectively followed 1096 patients to explore the association between reduced disease activity and improved HRQOL, and the influencing factors of improved HRQOL. The Short-Form 36 (SF-36) and SLE disease activity index (SLEDAI) were used to evaluate HRQOL and disease activity. RESULTS Chinese SLE patients had lower HRQOL than controls in all domains (P < 0.001), especially in role-physical (RP) and role-emotional (RE). Compared with SLE patients from outside China, the HRQOL of Chinese patients appeared to be higher in mental component summary (MCS) but lower in RP and RE. SLEDAI was negatively correlated with HRQOL, which was validated using the results of a follow-up study, where SLEDAI reduction was positively associated with HRQOL improvements (P < 0.05). Furthermore, personality, life nervous and experiences of adverse life events may influence HRQOL and HRQOL improvements. CONCLUSION SLE significantly affected the HRQOL of Chinese patients, especially in RP and RE. Disease activity was negatively correlated with HRQOL. We also found for the first time some factors affecting HRQOL, which can be regarded as the basis for improving the HRQOL of SLE patients.
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Affiliation(s)
- Yu-Hua Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China
- The Key Laboratory of Anhui Medical Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Hong-Yu Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China
- The Key Laboratory of Anhui Medical Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Yu-Qi Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China
- The Key Laboratory of Anhui Medical Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Xing-Yu Gong
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China
- The Key Laboratory of Anhui Medical Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Ying Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China
- The Key Laboratory of Anhui Medical Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Qi-Qun Zong
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China
- The Key Laboratory of Anhui Medical Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Guang-Hui Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China
- The Key Laboratory of Anhui Medical Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Wan-Qin Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China
- The Key Laboratory of Anhui Medical Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Chun-Xia Zhai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China
- The Key Laboratory of Anhui Medical Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Lin-Lin Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China
- The Key Laboratory of Anhui Medical Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Zi-Ye Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China
- The Key Laboratory of Anhui Medical Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Ting-Yu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China
- The Key Laboratory of Anhui Medical Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Jing Cai
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Mu Li
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Yang-Fan Chen
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Fang Wang
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yan-Feng Zou
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81, Meishan Road, Shushan District, Hefei, 230032, Anhui, China.
- The Key Laboratory of Anhui Medical Autoimmune Diseases, Hefei, 230032, Anhui, China.
- Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, 230032, Anhui, China.
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Leong KP, Tan JC, Thong BYH, Lian TY, Koh ET, Kong KO, Law WG, Chng HH, Chan GYL, Chia FL, Tan JWL, Howe HS, Chng HH, Howe HS, Koh ET, Kong KO, Lau TC, Leong KP, Thong BY, Lian TY, Cheng YK, Teh CL, Badsha H, Law WG, Chew LC, Yong WH, Chia FL, Chong EYY, Tan JWL. Medications impact different aspects of the quality of life of patients with systemic lupus erythematosus. Int J Rheum Dis 2022. [DOI: 10.1111/1756-185x.14446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Khai Pang Leong
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore City Singapore
| | - Joyce Ching‐Wen Tan
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore City Singapore
| | - Bernard Yu Hor Thong
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore City Singapore
| | - Tsui Yee Lian
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore City Singapore
| | - Ee Tzun Koh
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore City Singapore
| | - Kok Ooi Kong
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore City Singapore
| | - Weng Giap Law
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore City Singapore
| | - Hiok Hee Chng
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore City Singapore
| | - Grace Yin Lai Chan
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore City Singapore
| | - Faith Li‐Ann Chia
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore City Singapore
| | - Justina Wei Lynn Tan
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore City Singapore
| | - Hwee Siew Howe
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore City Singapore
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Borgia RE, Ugarte-Gil MF, Vilá LM, Reveille JD, McGwin G, Alarcón GS. Health-Related Quality of Life in Adults With Adolescent- and Adult-Onset Systemic Lupus Erythematosus: A Longitudinal Study of a Multiethnic US Cohort. Arthritis Care Res (Hoboken) 2022. [PMID: 36039942 DOI: 10.1002/acr.25006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/27/2022] [Accepted: 08/25/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The long-term impact of childhood-onset systemic lupus erythematosus (SLE) on health-related quality of life (HRQoL) in adult SLE patients in comparison to those with adult-onset SLE is unknown. We aim to examine and compare HRQoL trajectories in adults with adolescent- and adult-onset SLE. METHODS Patients enrolled in the LUpus in MInorities: NAture versus Nurture cohort were included. Adolescent-onset SLE were those diagnosed before 24 years of age, and adult-onset SLE were those diagnosed otherwise. Sociodemographic, clinical, medications, behavioral/psychological, and functioning data were obtained. Longitudinal trajectories of the physical component summary (PCS) and the mental component summary (MCS) Short Form 36 health survey scores were compared between the groups using a linear mixed model accounting for time-dependent and independent covariates. RESULTS A total of 470 SLE patients were included (95 with adolescent-onset SLE and 375 with adult-onset SLE). The mean ± SD age at diagnosis was 19.7 ± 2.8 years in the adolescent group and 39.3 ± 11.0 years in the adult group. The baseline PCS scores were higher (better physical functioning) in adolescent-onset SLE than in adult-onset SLE (38.9 versus 34.3, respectively; P < 0.001); however, the baseline MCS scores were comparable between the groups (41.4 versus 40.5, respectively; P = 0.53). The HRQoL improved equally in both groups with no statistically significant difference within and between the groups (last mean PCS and MCS scores 43.9 and 45.3 in adolescent-onset SLE; 38.1 and 43 in adult-onset SLE). CONCLUSIONS Adults with adolescent-onset SLE exhibited better physical functioning than those in the adult SLE group, despite more severe disease; noteworthy, HRQoL was below the general US population, despite clinically meaningful improvement in HRQoL over time in both groups.
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Affiliation(s)
- R Ezequiel Borgia
- University Hospitals, Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Manuel F Ugarte-Gil
- Hospital General Guillermo Almenara Irigoyen, EsSalud and Universidad Científica del Sur, Lima, Perú
| | - Luis M Vilá
- University of Puerto Rico, San Juan, Puerto Rico
| | | | | | - Graciela S Alarcón
- University of Alabama at Birmingham, Birmingham, and Universidad Peruana Cayetano Heredia, Lima, Perú
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Gao RC, Wu L, Shi PL, Sang N, Hao M, Wu GC. The impact of distress disclosure and anxiety on the association between social support and quality of life among Chinese women with systemic lupus erythematosus. Front Psychiatry 2022; 13:893235. [PMID: 35990077 PMCID: PMC9385970 DOI: 10.3389/fpsyt.2022.893235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/12/2022] [Indexed: 11/28/2022] Open
Abstract
The evidence on the relationship between social support and quality of life in female systemic lupus erythematosus (SLE) patients is complex. The purpose of this study was to explore the impacts of distress disclosure and anxiety on the association between social support and quality of life among Chinese women with SLE. A cross-sectional study was conducted, and 237 samples were obtained. Measures included demographic characteristics, Lupus Quality of Life (LupusQoL), social support rate scale (SSRS), distress disclosure index (DDI), and self-rating anxiety scale (SAS). Descriptive statistics, correlation analysis, and moderated mediating effect analysis were carried out. The LupusQoL was negatively correlated with age, systemic lupus erythematosus disease activity index (SLEDAI), DDI, and SAS. SSRS had a positive predictive effect on the LupusQoL, while SLEDAI and DDI had the opposite effect. SAS had a negative predictive effect on the LupusQoL. There were interactive effects of SAS and DDI on LupusQoL. In the moderated mediation model, SAS played moderating effect in the role of DDI on LupusQoL; the DDI of female patients with SLE played a partial mediator role, the mediation effect was 0.19, and the mediation effect ratio was 33.3%. In conclusion, to pay attention to the QOL, we should consider the mediator role of distress disclosure and the moderating role of anxiety.
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Affiliation(s)
- Rui-Chen Gao
- School of Nursing, Anhui Medical University, Hefei, China
| | - Li Wu
- School of Nursing, Anhui Medical University, Hefei, China
| | - Pei-Li Shi
- School of Nursing, Anhui Medical University, Hefei, China
| | - Ni Sang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Min Hao
- Department of Rheumatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Guo-Cui Wu
- School of Nursing, Anhui Medical University, Hefei, China
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Williams-Hall R, Berry P, Williamson N, Barclay M, Roberts A, Gater A, Tolley C, Bradley H, Ward A, Hsia E, Zuraw Q, DeLong P, Touma Z, Strand V. Generation of evidence supporting the content validity of SF-36, FACIT-F, and LupusQoL, and novel patient-reported symptom items for use in patients with systemic lupus erythematosus (SLE) and SLE with lupus nephritis (LN). Lupus Sci Med 2022; 9:e000712. [PMID: 36007978 PMCID: PMC9422858 DOI: 10.1136/lupus-2022-000712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/01/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE SLE and lupus nephritis (LN) have significant impacts on the health-related quality of life of patients living with the condition, which are important to capture from the patient's perspective using patient-reported outcomes (PROs). The objectives of this study were to evaluate the content validity of PROs commonly used in SLE and LN (36-Item Short Form Health Survey (SF-36), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) and Lupus Quality of Life (LupusQoL), as well as novel PRO symptom severity items measuring skin rash, joint pain, joint stiffness and swelling of the legs and/or feet, in both populations. METHODS Qualitative, semi-structured, cognitive interviews were conducted with 48 participants (SLE=28, LN=20). Understanding and relevance of symptom and impact PRO concepts from existing PROs were assessed, alongside novel PRO symptom severity items with different recall periods (24 hours vs 7 days) and response scales (Numerical Rating Scale (NRS) vs Verbal Rating Scale). Interviews were conducted in multiple rounds to allow for modifications to the novel PRO items. Analysis of verbatim interview transcripts was performed. RESULTS Symptom and impact concepts assessed by the SF-36, FACIT-F, and LupusQoL were well understood by both participants with SLE and LN (≥90.0%), with most considered relevant by over half of the participants asked (≥51.9%). All participants asked (100%) understood the novel PRO symptom severity items, and the majority (≥90.0%) considered the symptoms relevant. Minor modifications to the novel PRO items were made between rounds to improve clarity based on participant feedback. The selected 7-day recall period and NRS in the final iteration of the PRO items were understood and relevant. No differences in interview findings between the SLE and LN samples were identified. CONCLUSIONS Findings provide evidence of content validity for concepts assessed by the SF-36, FACIT-F, LupusQoL and the novel PRO symptom severity items, supporting use of these PROs to comprehensively assess disease impact in future SLE and LN clinical trials.
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Affiliation(s)
| | - Pamela Berry
- Patient Reported Outcomes, Janssen Global Services LLC, Titusville, Florida, USA
| | | | | | - Anna Roberts
- Patient-Centered Outcomes, Adelphi Values, Bollington, UK
| | - Adam Gater
- Patient-Centered Outcomes, Adelphi Values, Bollington, UK
| | - Chloe Tolley
- Patient-Centered Outcomes, Adelphi Values, Bollington, UK
| | - Helena Bradley
- Patient-Centered Outcomes, Adelphi Values, Bollington, UK
| | - Amy Ward
- Patient-Centered Outcomes, Adelphi Values, Bollington, UK
| | - Elizabeth Hsia
- Immunology Clinical Development, Janssen Research & Development LLC, Spring House, Pennsylvania, USA
- Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Qing Zuraw
- Immunology Clinical Development, Janssen Research & Development LLC, Spring House, Pennsylvania, USA
| | - Patricia DeLong
- Patient Reported Outcomes, Janssen Global Services LLC, Titusville, Florida, USA
| | - Zahi Touma
- Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, California, USA
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Radin M, El Hasbani G, Barinotti A, Roccatello D, Uthman I, Taher A, Sciascia S. Quality of life measures in Systemic Lupus Erythematosus: A systematic review. Reumatismo 2022; 73. [DOI: 10.4081/reumatismo.2021.1447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
Abstract
In this study we systematically investigated the health-related quality of life (HRQoL) tools, which have been most often used over the last five years to evaluate the QoL in patients with systemic lupus erythematosus (SLE), focusing on their items and applications. A detailed literature search was conducted: the inclusion criteria were as follows: 1) studies including at least 50 patients; 2) studies including at least 25 patients with SLE; 3) quality of life testing with validated measures. The systematic review was based on 119 studies for a total of 32,449 SLE patients and 3092 controls. A total of 35 different patients-reported quality of life measures, applied in cohorts of patients with SLE, were retrieved with the 36-item Medical Outcome Short Form (SF-36) (63 studies of 119 =52.95%), Lupus Quality of Life (LupusQoL) (17 studies =14.3%) and Lupus Patient-Reported Outcome (LupusPRO) (12 studies =10%) being the most commonly used tools. Overall, this systematic review of the literature indicated that quality of life in patients with SLE appears to be poor and generally lower compared to both the general population and patients with other chronic conditions, as was shown by a few studies that used SF-36 and LupusPRO. The use of HRQoL scoring in SLE is gaining increasing interest and is used both in randomized controlled trials and in real-life. Future efforts are needed to improve the understanding of the impact of the disease burden on quality of life from the patient’s perspective.
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Moazzami M, Katz P, Bonilla D, Engel L, Su J, Akhavan P, Anderson N, Tayer-Shifman OE, Beaton D, Touma Z. Validity and reliability of patient reported outcomes measurement information system computerized adaptive tests in systemic lupus erythematous. Lupus 2021; 30:2102-2113. [PMID: 34797991 PMCID: PMC8649426 DOI: 10.1177/09612033211051275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The evaluation of Patient Reported Outcomes Measurement Information System (PROMIS) computerized adaptive test (CAT) in adults with systemic lupus erythematous (SLE) is an emerging field of research. We aimed to examine the test-retest reliability and construct validity of the PROMIS CAT in a Canadian cohort of patients with SLE. METHODS Two hundred twenty-seven patients completed 14 domains of PROMIS CAT and seven legacy instruments during their clinical visits. Test-retest reliability of PROMIS was evaluated 7-10 days from baseline using intraclass correlation coefficient (ICC (2; 1)). The construct validity of the PROMIS CAT domains was evaluated against the commonly used legacy instruments, and also in comparison to disease activity and disease damage using Spearman correlations. A multitrait-multimethod matrix (MMM) approach was used to further assess construct validity comparing selected 10 domains of PROMIS and SF-36 domains. RESULTS Moderate to excellent reliability was found for all domains (ICC [2;1] ranging from lowest, 0.66 for Sleep Disturbance and highest, 0.93 for the Mobility domain). Comparing seven legacy instruments with 14 domains of PROMIS CAT, moderate to strong correlations (0.51-0.91) were identified. The average time to complete all PROMIS CAT domains was 11.7 min. The MMM further established construct validity by showing moderate to strong correlations (0.55-0.87) between select PROMIS and SF-36 domains; the average correlations from similar traits (convergent validity) were significantly greater than the average correlations from different traits. CONCLUSIONS These results provide evidence on the reliability and validity of PROMIS CAT in SLE in a Canadian cohort.
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Affiliation(s)
- Mitra Moazzami
- Department of Medicine, 43989The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Patricia Katz
- Department of Medicine and Health Policy, 8785University of California San Francisco, San Francisco, CA, USA
| | - Dennisse Bonilla
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital-Lupus Clinic, 7989University Health Network, Toronto, ON, Canada
| | - Lisa Engel
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, 8664University of Manitoba, Winnipeg, MB, Canada
| | - Jiandong Su
- Centre for Prognosis Studies in the Rheumatic Diseases, 7989University Health Network, Toronto, ON, Canada
| | - Pooneh Akhavan
- Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, 12366University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Nicole Anderson
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital-Lupus Clinic, 7989University Health Network, Toronto, ON, Canada
| | | | - Dorcas Beaton
- Health Measurement, St. Michael's Hospital, University of Toronto, 7966Institute for Work and Health, Toronto, ON, Canada
| | - Zahi Touma
- Division of Rheumatology, Department of Medicine; Toronto Western Hospital-Lupus Clinic; Institute of Health Policy, Management and Evaluation, 7938University of Toronto, Toronto, ON, Canada
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10
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Furie R, Morand EF, Bruce IN, Isenberg D, van Vollenhoven R, Abreu G, Pineda L, Tummala R. What Does It Mean to Be a British Isles Lupus Assessment Group-Based Composite Lupus Assessment Responder? Post Hoc Analysis of Two Phase III Trials. Arthritis Rheumatol 2021; 73:2059-2068. [PMID: 33913260 PMCID: PMC8596929 DOI: 10.1002/art.41778] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/16/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The British Isles Lupus Assessment Group-based Composite Lupus Assessment (BICLA) is a validated global measure of treatment response in systemic lupus erythematosus (SLE) clinical trials. To understand the relevance of BICLA in clinical practice, we investigated relationships between BICLA response and routine SLE assessments, patient-reported outcomes (PROs), and medical resource utilization. METHODS This was a post hoc analysis of pooled data from the phase III, randomized, placebo-controlled, 52-week TULIP-1 (ClinicalTrials.gov identifier: NCT02446912; n = 457) and TULIP-2 (ClinicalTrials.gov identifier: NCT02446899; n = 362) trials of intravenous anifrolumab (150/300 mg once every 4 weeks) in patients with moderate-to-severe SLE. Changes from baseline to week 52 in clinical assessments, PROs, and medical resource use were compared in BICLA responders versus nonresponders, regardless of treatment assignment. RESULTS BICLA responders (n = 318) achieved significantly improved outcomes compared with nonresponders (n = 501), including lower flare rates, higher rates of attainment of sustained oral glucocorticoid taper to ≤7.5 mg/day, greater improvements in PROs (Functional Assessment of Chronic Illness Therapy-Fatigue, Short Form 36 Health Survey), and fewer SLE-related hospitalizations/emergency department visits (all nominal P < 0.001). Compared with nonresponders, BICLA responders had greater improvements in global and organ-specific disease activity (Physician's Global Assessment, SLE Disease Activity Index 2000, Cutaneous Lupus Erythematosus Disease Area and Severity Index Activity, and joint counts; all nominal P < 0.001). BICLA responders had fewer lupus-related serious adverse events than nonresponders. CONCLUSION BICLA response is associated with clinical benefit in SLE assessments, PROs, and medical resource utilization, confirming its value as a clinical trial end point that is associated with measures important to patient care.
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Affiliation(s)
- Richard Furie
- Zucker School of Medicine at Hofstra/NorthwellGreat NeckNew York
| | | | - Ian N. Bruce
- University of ManchesterNIHR Manchester Biomedical Research CentreManchester University Hospitals NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
| | - David Isenberg
- University College London and University College HospitalLondonUK
| | | | | | - Lilia Pineda
- BioPharmaceuticals R&D, AstraZenecaGaithersburgMaryland
| | - Raj Tummala
- BioPharmaceuticals R&D, AstraZenecaGaithersburgMaryland
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11
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Nguyen MH, Huang FF, O’Neill SG. Patient-Reported Outcomes for Quality of Life in SLE: Essential in Clinical Trials and Ready for Routine Care. J Clin Med 2021; 10:jcm10163754. [PMID: 34442047 PMCID: PMC8396817 DOI: 10.3390/jcm10163754] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
Patient-reported outcome (PRO) instruments are widely used to assess quality of life in Systemic Lupus Erythematosus (SLE) research, and there is growing evidence for their use in clinical care. In this review, we evaluate the current evidence for their use in assessing quality of life in SLE in both research and clinical settings and examine the different characteristics of the commonly used PRO tools. There are now several well-validated generic and SLE-specific tools that have demonstrated utility in clinical trials and several tools that complement activity and damage measures in the clinical setting. PRO tools may help overcome physician–patient discordance in SLE and are valuable in the assessment of fibromyalgia and type 2 symptoms such as widespread pain and fatigue. Future work will identify optimal PRO tools for different settings but, despite current limitations, they are ready to be incorporated into patient care.
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Affiliation(s)
- Matthew H. Nguyen
- Liverpool Hospital, Liverpool, NSW 2170, Australia;
- Pathology Department, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Kensington, NSW 2052, Australia
| | - Frank F. Huang
- Rheumatology Department, Royal North Shore Hospital, St Leonards, NSW 2065, Australia;
| | - Sean G. O’Neill
- Rheumatology Department, Royal North Shore Hospital, St Leonards, NSW 2065, Australia;
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, St Leonards, NSW 2065, Australia
- Correspondence: ; Tel.: +61-02-94631890
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12
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Carrión-Nessi FS, Marcano-Rojas MV, Freitas-DeNobrega DC, Romero Arocha SR, Antuarez-Magallanes AW, Fuentes-Silva YJ. Validation of the LupusQoL in Venezuela: A specific measurement of quality of life in patients with systemic lupus erythematosus. ACTA ACUST UNITED AC 2021; 18:355-360. [PMID: 34373232 DOI: 10.1016/j.reumae.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/14/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Traditionally, the health-related quality of life (HRQoL) of patients with systemic lupus erythematosus (SLE) has been assessed using instruments that neglect the specific characteristics of the disease. This study determines the validity of the Lupus Quality of Life (LupusQoL) questionnaire as a psychometrically stable instrument to measure the HRQoL of patients with SLE in Venezuela and establishes the cutoff points of the questionnaire for the Venezuelan population. PATIENTS AND METHODS A cross-sectional study was conducted that included patients with SLE from April to July 2018. Patients completed the LupusQoL and the "Generalitat de Catalunya" (GENCAT) scale; sociodemographic data, activity index (SLEDAI) and accumulated damage (SLICC), were obtained. Reliability was evaluated by internal consistency and the convergent validity of the LupusQoL was determined with the GENCAT scale. RESULTS Of the 100 patients, 93% were women, the mean age was 42 years old (SD: 13) and the mean duration of the disease was 11 years (SD: 9); the mean of SLEDAI and SLICC was 3 and 1, respectively. The cutoff point that defined a "better" or "worse" HRQoL for LupusQoL was 64.55 points. A moderate convergence was found after grouping, according to the cutoff points, of the LupusQoL with the GENCAT scale (Cohen's kappa coefficient = .556; p = .000). CONCLUSIONS The LupusQoL is a valid psychometrically stable instrument to measure the HRQoL of patients with SLE in Venezuela. Cutoff points were established to stratify the HRQoL in the Venezuelan population with LES, being useful to complement a comprehensive evaluation.
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Affiliation(s)
- Fhabián S Carrión-Nessi
- Escuela de Ciencias de la Salud «Dr. Francisco Battistini Casalta», Universidad de Oriente-Núcleo Bolívar, Ciudad Bolívar, Venezuela.
| | - María V Marcano-Rojas
- Programa de Enfermedades Endocrino-Metabólicas, Instituto de Salud Pública, Ciudad Bolívar, Venezuela
| | - Diana C Freitas-DeNobrega
- Escuela de Ciencias de la Salud «Dr. Francisco Battistini Casalta», Universidad de Oriente-Núcleo Bolívar, Ciudad Bolívar, Venezuela
| | - Sinibaldo R Romero Arocha
- Programa de Formación de Científicos Médicos (MD/PhD), Facultad de Medicina, Universidad de Minnesota, MN, United States
| | - Allen W Antuarez-Magallanes
- Escuela de Ciencias de la Salud «Dr. Francisco Battistini Casalta», Universidad de Oriente-Núcleo Bolívar, Ciudad Bolívar, Venezuela
| | - Yurilís J Fuentes-Silva
- Escuela de Ciencias de la Salud «Dr. Francisco Battistini Casalta», Universidad de Oriente-Núcleo Bolívar, Ciudad Bolívar, Venezuela; Centro Clínico Universitario de Oriente, Ciudad Bolívar, Venezuela
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13
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Annapureddy N, Jolly M. Patient-Reported Outcomes in Lupus. Rheum Dis Clin North Am 2021; 47:351-378. [PMID: 34215368 DOI: 10.1016/j.rdc.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Patient-reported outcome (PRO) was identified as a core systemic lupus erythematosus (SLE) outcome in 1999. More than 20 years later, however, generic PRO measures evaluating impact in SLE are used mainly for research. Generic and disease-targeted PRO tools have unique advantages. Significant progress in identification of patient disease-relevant PRO concepts and development of new PRO tools for SLE has occurred over the past 20 years. Further research needs to focus on responsiveness and minimally important differences of existing, promising PRO tools to facilitate their use in SLE patient care and research.
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Affiliation(s)
- Narender Annapureddy
- Department of Medicine, Vanderbilt University, 1160 21st Avenue, Suite T3113 MCN, Nashville, TN 37232, USA
| | - Meenakshi Jolly
- Department of Medicine, Rush University, 1611 West Harrison Street, Suite 510, Chicago, IL 60615, USA.
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14
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Strand V, Simon LS, Meara AS, Touma Z. Measurement properties of selected patient-reported outcome measures for use in randomised controlled trials in patients with systemic lupus erythematosus: a systematic review. Lupus Sci Med 2021; 7:7/1/e000373. [PMID: 32591423 PMCID: PMC7319706 DOI: 10.1136/lupus-2019-000373] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/17/2020] [Accepted: 05/24/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The heterogeneous multisystem manifestations of SLE include fatigue, pain, depression, sleep disturbance and cognitive dysfunction, and underscore the importance of a multidimensional approach when assessing health-related quality of life. The US Food and Drug Administration has emphasised the importance of patient-reported outcomes (PROs) for approval of new medications and Outcome Measures in Rheumatology has mandated demonstration of appropriate measurement properties of selected PRO instruments. METHODS Published information regarding psychometric properties of the Medical Outcomes Survey Short Form 36 (SF-36), Lupus Quality of Life Questionnaire (LupusQoL) and Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-F), and their suitability as end points in randomised controlled trials (RCTs) and longitudinal observational studies (LOS) were assessed. A search of English-language literature using MEDLINE and EMBASE identified studies related to development and validation of these instruments. Evidence addressed content validity, reliability (internal consistency and test-retest reliability), construct validity (convergent and divergent) and longitudinal responsiveness, including thresholds of meaning and discrimination. RESULTS All instruments demonstrated strong internal consistency, reliability and appropriate face/content validity, indicating items within each instrument that measure the intended concept. SF-36 and LupusQoL demonstrated test-retest reliability; although not published with FACIT-F in SLE supported by evidence from other rheumatic diseases. All instruments demonstrated convergent validity with other comparable PROs and responsivity to treatment. CONCLUSION The measurement properties of PRO instruments with published data from RCTs including: SF-36, LupusQoL and FACIT-F indicate their value as secondary end points to support labelling claims in RCTs and LOS evaluating the efficacy of SLE treatments.
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Affiliation(s)
- Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, California, USA
| | | | | | - Zahi Touma
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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15
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Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking (APS ACTION): 10-Year Update. Curr Rheumatol Rep 2021; 23:45. [PMID: 33932165 PMCID: PMC8088198 DOI: 10.1007/s11926-021-01008-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 12/14/2022]
Abstract
Purpose of Review APS ACTION is an international research network created to design and conduct large-scale, multicenter research in persistently antiphospholipid antibody (aPL)–positive patients. Given the expanding research activities of the network in the last decade since its creation, the purpose of this article is to review the scientific contributions of APS ACTION as well as future directions. Recent Findings APS ACTION has achieved increased international collaboration with internal and external investigators for outcome, interventional, and mechanistic antiphospholipid syndrome (APS) studies. This has been linked to substantial progress in Core laboratory work, which has demonstrated that laboratories can achieve good agreement in performance of aPL assays by use of the same reagents, analyzer type, and protocols. Summary APS ACTION will continue to identify gaps in the existing aPL/APS literature, design mechanistic studies to elucidate underlying mechanisms, and conduct prospective, large-scale clinical studies, all for the ultimate goal of early diagnosis and improved management of aPL-positive patients.
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16
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Carrión-Nessi FS, Marcano-Rojas MV, Freitas-DeNobrega DC, Romero Arocha SR, Antuarez-Magallanes AW, Fuentes-Silva YJ. Validation of the LupusQoL in Venezuela: A Specific Measurement of Quality of Life in Patients with Systemic Lupus Erythematosus. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00061-9. [PMID: 33931336 DOI: 10.1016/j.reuma.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/02/2020] [Accepted: 02/14/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Traditionally, the health-related quality of life (HRQoL) of patients with systemic lupus erythematosus (SLE) has been assessed using instruments that neglect the specific characteristics of the disease. This study determines the validity of the Lupus Quality of Life (LupusQoL) questionnaire as a psychometrically stable instrument to measure the HRQoL of patients with SLE in Venezuela and establishes the cutoff points of the questionnaire for the Venezuelan population. PATIENTS AND METHODS A cross-sectional study was conducted that included patients with SLE from April to July 2018. Patients completed the LupusQoL and the Generalitat de Catalunya (GENCAT) scale; sociodemographic data, activity index (SLEDAI) and accumulated damage (SLICC), were obtained. Reliability was evaluated by internal consistency and the convergent validity of the LupusQoL was determined with the GENCAT scale. RESULTS Of the 100 patients, 93% were women, the mean age was 42years old (SD: 13) and the mean duration of the disease was 11years (SD: 9); the mean of SLEDAI and SLICC was 3 and 1, respectively. The cutoff point that defined a "better" or "worse" HRQoL for LupusQoL was 64.55 points. A moderate convergence was found after grouping, according to the cutoff points, of the LupusQoL with the GENCAT scale (Cohen's kappa coefficient=.556; p=.000). CONCLUSIONS The LupusQoL is a valid psychometrically stable instrument to measure the HRQoL of patients with SLE in Venezuela. Cutoff points were established to stratify the HRQoL in the Venezuelan population with LES, being useful to complement a comprehensive evaluation.
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Affiliation(s)
- Fhabián S Carrión-Nessi
- Escuela de Ciencias de la Salud «Dr. Francisco Battistini Casalta», Universidad de Oriente-Núcleo Bolívar, Ciudad Bolívar, Venezuela.
| | - María V Marcano-Rojas
- Programa de Enfermedades Endocrino-Metabólicas, Instituto de Salud Pública, Ciudad Bolívar, Venezuela
| | - Diana C Freitas-DeNobrega
- Escuela de Ciencias de la Salud «Dr. Francisco Battistini Casalta», Universidad de Oriente-Núcleo Bolívar, Ciudad Bolívar, Venezuela
| | - Sinibaldo R Romero Arocha
- Programa de Formación de Científicos Médicos (MD/PhD), Facultad de Medicina, Universidad de Minnesota, Minnesota, Estados Unidos
| | - Allen W Antuarez-Magallanes
- Escuela de Ciencias de la Salud «Dr. Francisco Battistini Casalta», Universidad de Oriente-Núcleo Bolívar, Ciudad Bolívar, Venezuela
| | - Yurilís J Fuentes-Silva
- Escuela de Ciencias de la Salud «Dr. Francisco Battistini Casalta», Universidad de Oriente-Núcleo Bolívar, Ciudad Bolívar, Venezuela; Centro Clínico Universitario de Oriente, Ciudad Bolívar, Venezuela
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17
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Fung W, Lim LSH, Tomlinson G, Engel L, Su J, Diaz-Martinez JP, Touma Z. Joint trajectories of disease activity, and physical and mental health-related quality of life in an inception lupus cohort. Rheumatology (Oxford) 2021; 59:3032-3041. [PMID: 32191334 DOI: 10.1093/rheumatology/keaa091] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/31/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To examine for latent patterns of SLE disease activity trajectories that associate with specific latent patterns of health-related quality of life (HRQoL; Medical Outcomes Study Short Form-36), and to determine baseline predictors of class membership. METHODS In this retrospective longitudinal inception cohort of 222 SLE adults over 10 years, trajectories of three outcomes were studied jointly: Short Form-36 physical (PCS) and mental (MCS) component summaries and adjusted mean SLEDAI-2000 (AMS). Group-based joint trajectory modelling was used to model latent classes; univariable and multivariable analyses were used to identify predictors of class membership. RESULTS Four latent classes were identified: Class 1 (C1) (24%) had moderate AMS, and persistently low PCS and MCS; C2 (26%) had low AMS, moderate PCS and improved then worsened MCS; C3 (38%) had moderate AMS, and persistently high PCS and MCS; and C4 (11%) had high AMS, moderate-low PCS and improving MCS. Baseline older age was associated with lower HRQoL trajectories. Higher AMS trajectories did not associate with a particular pattern of HRQoL trajectory. A higher prevalence of fibromyalgia (44% in C1) was associated with worse HRQoL trajectories. Disease manifestations, organ damage and cumulative glucocorticoid were not differentially distributed across the latent classes. CONCLUSION High disease activity did not necessarily associate with low HRQoL. More patients with worse HRQoL trajectories had fibromyalgia. Older age at diagnosis increased the probability of belonging to a class with low HRQoL trajectories. The care of SLE patients may be improved through addressing fibromyalgia in addition to disease activity.
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Affiliation(s)
- William Fung
- Department of Rheumatology, University of Toronto, Toronto, Ontario
| | - Lily Siok Hoon Lim
- Max Rady Faculty of Health Sciences, Children's Hospital Research Institute of Manitoba, University of Manitoba, Manitoba
| | - George Tomlinson
- Institute of Health Policy, University of Toronto, Toronto, Ontario
| | - Lisa Engel
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Manitoba
| | - Jiandong Su
- Department of Rheumatology, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, University of Toronto Lupus Clinic, Toronto, Ontario, Canada
| | | | - Zahi Touma
- Institute of Health Policy, University of Toronto, Toronto, Ontario.,Department of Rheumatology, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, University of Toronto Lupus Clinic, Toronto, Ontario, Canada
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18
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Almeida-Brasil CC, Pineau CA, Vinet E, Hanly JG, Peschken CA, Clarke AE, Fortin PR, Abrahamowicz M, Bernatsky S. Predictors of unsuccessful hydroxychloroquine tapering and discontinuation: Can we personalize decision-making in systemic lupus treatment? Arthritis Care Res (Hoboken) 2020; 74:1070-1078. [PMID: 33369255 PMCID: PMC9544951 DOI: 10.1002/acr.24548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/16/2020] [Accepted: 12/17/2020] [Indexed: 11/28/2022]
Abstract
Objective Hydroxychloroquine (HCQ) is a key systemic lupus erythematosus (SLE) drug, making concerns of drug shortages grave. Our objective was to evaluate factors associated with poor outcomes after HCQ taper or discontinuation in SLE. Methods We studied 5 Canadian SLE cohorts between 1999 and 2019, following patients from the date of HCQ tapering (cohort 1) or discontinuation (cohort 2). A composite outcome was defined as any of the following: a need for therapy augmentation, an increase (of at least 4 points) in the Systemic Lupus Erythematosus Disease Activity Index 2000 score, or hospitalization for SLE. In each cohort, multivariable Cox regression was used to identify demographic and clinical factors associated with time to the earliest of these events. A third cohort continuing to receive HCQ was also studied, to assess whether the same factors influenced the outcome even when the HCQ dose was unchanged. Results The poor outcome rate, per 100 person‐years, was 35.7 (95% confidence interval [95% CI] 31.6–40.3) in the HCQ taper cohort (n = 398), 29.0 (95% CI 25.5–33.0) in the discontinuation cohort (n = 395), and 16.1 (95% CI 13.2–19.6) in the maintenance cohort (n = 395). In patients tapering HCQ, baseline prednisone use was independently associated with greater risk of poor outcomes. In the discontinuation cohort, the risk of poor outcomes was greater for Black patients and those diagnosed with SLE at age ≤25 years. Among those maintaining HCQ, baseline immunosuppressive use and First Nations ethnicity were associated with poor outcomes. Conclusion We identified demographic and clinical factors associated with poor outcomes after HCQ taper/discontinuation. This information is critical in the current setting of potential shortages, but over the long term, such information could inform personalized therapies.
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Affiliation(s)
- Celline C Almeida-Brasil
- Department of Medicine, Division of Rheumatology and Division of Clinical Epidemiology and Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Quebec, Canada
| | - Christian A Pineau
- Department of Medicine, Division of Rheumatology and Division of Clinical Epidemiology and Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Quebec, Canada
| | - Evelyne Vinet
- Department of Medicine, Division of Rheumatology and Division of Clinical Epidemiology and Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Quebec, Canada
| | - John G Hanly
- Department of Medicine, Division of Rheumatology and Division of Clinical Epidemiology and Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Quebec, Canada
| | - Christine A Peschken
- Department of Medicine, Division of Rheumatology and Division of Clinical Epidemiology and Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Quebec, Canada
| | - Ann E Clarke
- Department of Medicine, Division of Rheumatology and Division of Clinical Epidemiology and Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Quebec, Canada
| | - Paul R Fortin
- Department of Medicine, Division of Rheumatology and Division of Clinical Epidemiology and Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Quebec, Canada
| | - Michal Abrahamowicz
- Department of Medicine, Division of Rheumatology and Division of Clinical Epidemiology and Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Quebec, Canada
| | - Sasha Bernatsky
- Department of Medicine, Division of Rheumatology and Division of Clinical Epidemiology and Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Quebec, Canada
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Izadi Z. Health‐Related Quality of Life Measures in Adult Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:577-592. [DOI: 10.1002/acr.24245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/28/2020] [Indexed: 12/31/2022]
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20
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Gaspar P, Cohen H, Isenberg DA. The assessment of patients with the antiphospholipid antibody syndrome: where are we now? Rheumatology (Oxford) 2020; 59:1489-1494. [PMID: 32359070 DOI: 10.1093/rheumatology/keaa172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/27/2020] [Accepted: 02/10/2020] [Indexed: 11/14/2022] Open
Abstract
The antiphospholipid antibody syndrome (APS), a chronic autoimmune thrombophilia with an increased mortality and morbidity, has been recognized for more than three decades. Unlike other autoimmune rheumatic conditions such as systemic lupus erythematosus, myositis and Sjögren's syndrome, relatively few attempts have been made to develop activity, damage or disease-specific quality of life indices for APS. In this review of the literature, we consider those attempts that have been made to develop assessment tools for patients with APS, but also reflect upon the nature of the condition, to discuss, in particular, whether an activity index is appropriate for this disease.
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Affiliation(s)
- Pedro Gaspar
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Internal Medicine, Hospital de Santa Maria, Lisbon, Portugal
| | - Hannah Cohen
- Department of Haematology, University College London Hospitals NHS Foundation Trust.,Haemostasis Research Unit, Department of Haematology, University College London
| | - David A Isenberg
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.,Centre for Rheumatology, Division of Medicine, University College London, London, UK
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Corneloup M, Maurier F, Wahl D, Muller G, Aumaitre O, Seve P, Blaison G, Pennaforte JL, Martin T, Magy-Bertrand N, Berthier S, Arnaud L, Bourredjem A, Amoura Z, Devilliers H. Disease-specific quality of life following a flare in systemic lupus erythematosus: an item response theory analysis of the French EQUAL cohort. Rheumatology (Oxford) 2020; 59:1398-1406. [PMID: 31620787 DOI: 10.1093/rheumatology/kez451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/30/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore, at an item-level, the effect of disease activity (DA) on specific health-related quality of life (HRQoL) in SLE patients using an item response theory longitudinal model. METHODS This prospective longitudinal multicentre French cohort EQUAL followed SLE patients over 2 years. Specific HRQoL according to LupusQoL and SLEQOL was collected every 3 months. DA according to SELENA-SLEDAI flare index (SFI) and revised SELENA-SLEDAI flare index (SFI-R) was evaluated every 6 months. Regarding DA according to SFI and each SFI-R type of flare, specific HRQoL of remitting patients was compared with non-flaring patients fitting a linear logistic model with relaxed assumptions for each domain of the questionnaires. RESULTS Between December 2011 and July 2015, 336 patients were included (89.9% female). LupusQoL and SLEQOL items related to physical HRQoL (physical health, physical functioning, pain) were most affected by musculoskeletal and cutaneous flares. Cutaneous flares had significant influence on self-image. Neurological or psychiatric flares had a more severe impact on specific HRQoL. Patient HRQoL was impacted up to 18 months after a flare. CONCLUSION Item response theory analysis is able to pinpoint items that are influenced by a given patient group in terms of a latent trait change. Item-level analysis provides a new way of interpreting HRQoL variation in SLE patients, permitting a better understanding of DA impact on HRQoL. This kind of analysis could be easily implemented for the comparison of groups in a clinical trial. TRIAL REGISTRATION ClinicalTrials.gov, http://clinicaltrials.gov, NCT01904812.
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Affiliation(s)
- Marie Corneloup
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon
| | - François Maurier
- Department of Internal Medicine and Clinical Immunology, Site Belle Isle, Metz
| | - Denis Wahl
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, CHRU de Nancy.,Inserm UMR_S 1116 at Lorraine University, Nancy
| | - Geraldine Muller
- Internal Medicine and Systemic Diseases Unit, University Hospital Centre Dijon, Dijon
| | - Olivier Aumaitre
- Department of Internal Medicine, Centre Hospitalier Universitaire, Hôpital Gabriel Montpied, Clermont-Ferrand
| | - Pascal Seve
- Department of Internal Medicine, University Hospital, Hôpital Croix Rousse, Lyon
| | - Gilles Blaison
- Department of Internal Medicine, Hopital Louis Pasteur, Colmar, Alsace
| | | | - Thierry Martin
- Internal Medicine and Clinical Immunology Department, Strasbourg University Hospital, Strasbourg
| | | | - Sabine Berthier
- Internal Medicine and Clinical Immunology Unit, University Hospital Dijon-Burgundy, Dijon
| | - Laurent Arnaud
- Department of Rheumatology, Hôpitaux Universitaires de Strasbourg.,INSERM UMR-S 1109, Strasbourg
| | - Abderrahmane Bourredjem
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon
| | - Zahir Amoura
- Department of Internal Medicine, National Referral Center for Systemic Lupus Erythematosus and Anti-Phospholipid Syndrome, Pitie-Salpetriere University Hospital, Paris, France
| | - Hervé Devilliers
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon
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Abstract
Background and PurposeSystemic Lupus Erythematosus negatively affects health related quality of life (HRQOL). The purpose of this review is to synthesize and evaluate findings related to the psychometric properties of the LupusQoL and its variations.MethodsA search of CINAHL, PubMed, and Medline for the timeframe of 2007–2019 for English-language articles using any form of the LupusQoL was completed. Thirty-five studies were reviewed to determine psychometric soundness.ResultsCronbach alpha results supported the internal consistency with test–retest data supporting stability. Factor structure and Scree plots varied. Content, construct, criterion, convergent, and discriminate validity were supported. Ceiling and floor effects occurred.ConclusionsThe LupusQoL and its variations offer a disease-specific measure with supported reliability and validity for use in culturally disparate populations. Factor structure and ceiling/floor effects need further edification.
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Jolly M, Annapureddy N, Arnaud L, Devilliers H. Changes in quality of life in relation to disease activity in systemic lupus erythematosus: post-hoc analysis of the BLISS-52 Trial. Lupus 2019; 28:1628-1639. [PMID: 31674267 DOI: 10.1177/0961203319886065] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To quantify changes in generic patient-reported outcomes against clinically meaningful, disease activity measures in systemic lupus erythematosus (SLE). METHODS Using BLISS-52 trial data (867 SLE patients), we estimated the mean difference in change of patient-reported outcome scores (Medical Outcomes Study SF-36 and FACIT-fatigue) in relation to disease activity (SELENA-SLEDAI, SELENA-SLEDAI flare index, SLE responder index and British Isles Lupus Assessment Group (BILAG)), considering all study visits by the mean of multivariate mixed models. Predefined disease activity criteria were used to define for improvement and worsening. RESULTS Mean changes in physical component summary/mental component summary and FACIT-fatigue in response to changes in SELENA-SLEDAI and SELENA-SLEDAI flare index were significantly lower than 2.5. New SELENA-SLEDAI flare index flare led to a significant change in all patient-reported outcome scores, except role emotional. Mean improvement in patient-reported outcomes with achievement of SLE responder index ranged between +6.2 (physical function) and +11.3 (bodily pain) for SF-36 domains, + 3.4 and +3.3 for mental component summary and physical component summary, and was +4.2 for FACIT-fatigue. When considering disease activity changes by organ system, changes in BILAG (constitutional) was independently associated with significant changes in FACIT-fatigue and all SF-36 domains (except physical function), changes in BILAG (musculoskeletal and hematological) were independently associated with significant changes in patient-reported outcome scores, except for role emotional (musculoskeletal) and general health/mental health (hematological). Mean changes in every SF-36 domain varied (and was >5) with SLE responder index attainment. CONCLUSIONS Knowledge of changes in patient-reported outcomes, against clinically meaningful changes in SLE disease activity measures, is crucial for designing of clinical trials, interpretation of results and shared decision-making for patient care.
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Affiliation(s)
- M Jolly
- Division of Rheumatology, Rush University Medical Center, Chicago, USA
| | - N Annapureddy
- Division of Rheumatology, Vanderbilt University Medical Center, Nashville, USA
| | - L Arnaud
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, INSERM UMRS 1109, CRMR RESO, Strasbourg, France
| | - H Devilliers
- Internal Medicine and Systemic Diseases Unit, Dijon University Hospital, Dijon, France.,INSERM CIC-1432 Clinical Investigation Center - Clinical Epidemiology, Dijon University Hospital, Dijon, France
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Azizoddin DR, Jolly M, Arora S, Yelin E, Katz P. Patient-Reported Outcomes Predict Mortality in Lupus. Arthritis Care Res (Hoboken) 2019; 71:1028-1035. [PMID: 30144293 DOI: 10.1002/acr.23734] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/21/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Physician-assessed disease activity and damage predict mortality in systemic lupus erythematosus (SLE). Patient-reported outcomes (PROs) are known predictors of mortality in other chronic diseases, but this relationship has not been well examined in SLE. The aim of the present study was to assess whether PROs predict mortality in SLE. METHODS Data were derived from the University of California at San Francisco Lupus Outcomes Study (n = 728). PROs (Medical Outcomes Study Short Form 36 [SF-36] subscales), self-rated health, and depression (Center for Epidemiologic Studies Depression scale [CES-D]) from 2007 (baseline data [T0]) were used to predict mortality (censored 2015). Univariate Cox regression analyses were completed for each PRO as a predictor of mortality, and multivariate Cox regression with covariates for each PRO separately. Covariates were age, sex, race/ethnicity, poverty, disease duration, disease activity (Systemic Lupus Activity Questionnaire), and damage (Brief Index of Lupus Damage). RESULTS The mean ± SD age of patients was 50.6 ± 12.6 years. Ninety-two percent of patients were women and 68.5% were white. There were 71 deaths (9.1%). In univariate analyses, both the SF-36 physical component subscale score and self-rated health were associated with mortality, and the SF-36 mental health subscale and CES-D scores were not associated with mortality. In multivariate analyses, lower scores of SF-36 physical function at T0 independently predicted mortality after controlling for all other covariates (hazard ratio 0.97 [95% confidence interval 0.94-0.99]; P < 0.01). CONCLUSION Patient-reported physical function independently predicted mortality in SLE, even after accounting for demographics (including poverty) and disease (duration, activity, and damage). Because PROs are easy to assess, they may be used to triage, track, and guide early interventions for those at high risk of mortality in SLE.
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Affiliation(s)
| | | | | | - Ed Yelin
- University of California at San Francisco
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Yaghubi M, Zargar F. Effectiveness of Mindfulness-based Relapse Prevention on Quality of Life and Craving in Methadone-treated Patients: A Randomized Clinical Trial. ADDICTION & HEALTH 2019; 10:250-259. [PMID: 31263524 PMCID: PMC6593172 DOI: 10.22122/ahj.v10i4.573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Quality of life (QOL) is always considered as a final consequence of clinical trials, interventions, and health care. The results of studies indicate that addiction leads to lower QOL. However, studies have been conducted on the effectiveness of mindfulness-based interventions on improving QOL. The aim of this study was to investigate the efficacy of mindfulness-based relapse prevention (MBRP) on QOL and craving in methadone-treated patients. Methods This study was conducted in Qom, Iran, in 2017. A sample of 70 methadone-treated patients were randomly selected and assigned to two groups (intervention and control). Participants in both groups completed the 36-item Short Form (SF-36) QOL Questionnaire and Craving Beliefs Questionnaire (CBQ) at the beginning of the study (pre-test), 8 weeks after the study (post-test), and two months after the study (follow up). In this study, the experimental group received 8 training sessions on mindfulness prevention, while the control group did not receive general information about addiction and did not receive any psychological intervention. Finally, data of 63 patients were analyzed with the SPSS software, chi-square test, t-test, and repeated-measures ANOVA. Findings The results of repeated-measures ANOVA showed that there was no significant difference between intervention and control groups in the pre-test, but MBRP in the intervention group significantly increased the scores of QOL and decreased the scores of craving, significantly (P < 0.001). Conclusion The findings of present study indicate that MBRP training can increase the psychological and physical health in dependent methadone-treated patients and decrease craving. These findings suggest that mindfulness training can be used as an effective intervention for improving QOL and reducing craving.
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Affiliation(s)
- Mehdi Yaghubi
- Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Zargar
- Associate Professor, Department of Psychiatry, School of Medicine AND Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Strand V, Berry P, Lin X, Asukai Y, Punwaney R, Ramachandran S. Long-Term Impact of Belimumab on Health-Related Quality of Life and Fatigue in Patients With Systemic Lupus Erythematosus: Six Years of Treatment. Arthritis Care Res (Hoboken) 2019; 71:829-838. [PMID: 30320964 PMCID: PMC6593666 DOI: 10.1002/acr.23788] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 10/09/2018] [Indexed: 12/24/2022]
Abstract
Objective To report long‐term health‐related quality of life (HRQoL) and fatigue outcomes in patients with systemic lupus erythematosus (SLE) receiving belimumab. Methods Patients with SLE who completed the Study of Belimumab in Subjects with SLE 76‐week trial (BLISS‐76) were enrolled in this continuation study (BEL112233 [ClinicalTrials.gov identifier: NCT00724867]). The belimumab groups continued to receive the same dose (1 mg/kg or 10 mg/kg) intravenously. After March 2011, all patients received belimumab 10 mg/kg every 28 days plus standard therapy. The placebo group switched to belimumab 10 mg/kg. HRQoL and fatigue assessments included the Short Form 36 (SF‐36) health survey and the Functional Assessment of Chronic Illness Therapy (FACIT)–Fatigue subscale. Post hoc subgroup analyses (BEL206350) assessed clinical characteristics associated with improved HRQoL and fatigue. Results Of the 268 patients enrolled, 140 completed the study. Patients receiving long‐term belimumab treatment reported continued improvements in HRQoL and fatigue. At study year 6, the mean ± SD SF‐36 physical component summary (PCS) score and the mental component summary (MCS) score increased from 37.0 ± 9.9 at baseline to 41.7 ± 10.0 (mean ± SD change 4.8 ± 9.4) and from 44.3 ± 11.3 to 47.0 ± 11.6 (mean ± SD change 2.7 ± 11.3) for the PCS and MCS, respectively, exceeding the minimum clinically important difference (MCID) for improvement (2.5 units). The mean ± SD FACIT–Fatigue score exceeded the MCID of 4 at study years 1–5; at study year 6, the mean ± SD change was 3.7 ± 11.8. Statistically significant associations were observed between parent trial treatment groups and change from baseline in PCS, MCS, and FACIT–Fatigue scores (P < 0.01). Conclusion Long‐term control of SLE disease activity with belimumab plus standard therapy translates into meaningful improvements in patient‐reported fatigue and HRQoL.
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Affiliation(s)
- Vibeke Strand
- Stanford University School of Medicine, Palo Alto, California
| | | | - Xiwu Lin
- GlaxoSmithKline, Philadelphia, Pennsylvania
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Bangert E, Wakani L, Merchant M, Strand V, Touma Z. Impact of belimumab on patient-reported outcomes in systemic lupus erythematosus: review of clinical studies. PATIENT-RELATED OUTCOME MEASURES 2019; 10:1-7. [PMID: 30666173 PMCID: PMC6330963 DOI: 10.2147/prom.s134326] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune, multisystem rheumatic disease with significant impact on health-related quality of life (HRQoL). Patient-reported outcomes (PROs) provide valuable data on patient perceptions across a variety of domains, such as HRQoL, pain, fatigue, and depression. The measurement and results of PROs with respect to HRQoL in randomized controlled trials (RCTs) on belimumab (B-lymphocyte stimulator inhibitor) in SLE are reviewed here, including BLISS-52 and BLISS-76, as well as publications related to belimumab trials that included HRQoL data. Other trials that evaluated belimumab did not include HRQoL data and were therefore not included in the analysis. The BLISS-52 and BLISS-76 RCTs met their primary endpoints and demonstrated improvements in PROs, measured by the 36-item Short Form Health Survey, EuroQol 5 Dimensions, and Functional Assessment of Chronic Illness Therapy-Fatigue Scale. Belimumab was shown overall to improve PROs in adult autoantibody-positive lupus patients.
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Affiliation(s)
- Elvira Bangert
- Division of Rheumatology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Laura Wakani
- University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto, ON, Canada,
| | - Mehveen Merchant
- Division of Rheumatology, Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, CA, USA
| | - Zahi Touma
- University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto, ON, Canada,
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Mikdashi J. Measuring and monitoring health-related quality of life responsiveness in systemic lupus erythematosus patients: current perspectives. PATIENT-RELATED OUTCOME MEASURES 2018; 9:339-343. [PMID: 30323697 PMCID: PMC6178935 DOI: 10.2147/prom.s109479] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective Little is known about health-related quality of life (HRQoL) responsiveness in systemic lupus erythematosus (SLE) patients, compared to other chronic diseases. This review summarizes the available data in HRQoL responsiveness and sensitivity to change in SLE, and recommends directions for research and clinical application. Methods A review of the literature was conducted reporting on HRQoL responsiveness in adult SLE patients between 1984 and 2018. HRQoL studies were assessed for responsiveness, sensitivity of change, minimal important differences, minimal clinical important differences, or change in improvement or deterioration. Results Responsiveness or sensitivity to change in health-related status was observed in Medical Outcome Survey Short Form-36, SLE Symptom Checklist, EuroQoL, and Medical Outcomes Study Short Form 6D. SLE-specific quality of life questionnaire demonstrated greater responsiveness than the individual domains of SF-36. Lupus quality of life showed large responsiveness when there was improvement. LupusPRO and its derivative Lupus Impact Tracker were found to be responsive to change in disease activity, reflecting both improvement and worsening. Lupus Impact Tracker and physical health and pain domains of Lupus quality of life were responsive to SLE composite responder index. Conclusion This review highlights the need for further studies that capture responsiveness and change in HRQoL that are clinically meaningful and sustained. Most importantly, the choice of one measure over another is influenced by the purpose of the HRQoL measure, the particular HRQoL domain, and the SLE disease state that are relevant to the research question.
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Affiliation(s)
- Jamal Mikdashi
- Division of Rheumatology and Clinical Immunology, University of Maryland School of Medicine, Baltimore, MD 21201, USA,
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Izadi Z, Gandrup J, Katz PP, Yazdany J. Patient-reported outcome measures for use in clinical trials of SLE: a review. Lupus Sci Med 2018; 5:e000279. [PMID: 30167315 PMCID: PMC6109821 DOI: 10.1136/lupus-2018-000279] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/19/2018] [Accepted: 07/21/2018] [Indexed: 12/16/2022]
Abstract
Inclusion of patient-reported outcomes is important in SLE clinical trials as they allow capture of the benefits of a proposed intervention in areas deemed pertinent by patients. We aimed to compare the measurement properties of health-related quality of life (HRQoL) measures used in adults with SLE and to evaluate their responsiveness to interventions in randomised controlled trials (RCTs). A systematic review was undertaken using full original papers in English identified from three databases: MEDLINE, EMBASE and PubMed. Studies describing the validation of HRQoL measures in English-speaking adult patients with SLE and SLE drug RCTs that used an HRQoL measure were retrieved. Twenty-five validation papers and 26 RCTs were included in the indepth review evaluating the measurement properties of 4 generic (Medical Outcomes Study Short-Form 36 (SF36), Patient Reported Outcomes Measurement Information System (PROMIS) item-bank, EuroQol-5D, and Functional Assessment of Chronic Illness Therapy-Fatigue) and 3 disease-specific (Lupus Quality of Life (LupusQoL), Lupus Patient Reported Outcomes, Lupus Impact Tracker (LIT)) instruments. All measures had good convergent and discriminant validity. PROMIS provided the strongest evidence for known-group validity and reliability among generic instruments; however, data on its responsiveness have not been published. Across measures, standardised response means were generally indicative of poor-moderate sensitivity to longitudinal change. In RCTs, clinically important improvements were reported in SF36 scores from baseline; however, between-arm differences were frequently non-significant and non-important. SF36, PROMIS, LupusQoL and LIT had the strongest evidence for acceptable measurement properties, but few measures aside from the SF36 have been incorporated into clinical trials. This review highlights the importance of incorporating a broader range of SLE-specific HRQoL measures in RCTs and warrants further research that focuses on longitudinal responsiveness of newer instruments.
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Affiliation(s)
- Zara Izadi
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Julie Gandrup
- Division of Rheumatology, University of California, San Francisco, California, USA
| | - Patricia P Katz
- Division of Rheumatology, University of California, San Francisco, California, USA
| | - Jinoos Yazdany
- Division of Rheumatology, University of California, San Francisco, California, USA
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