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Tanaka Y, Atsumi T, Okada M, Miyamura T, Ishii T, Nishiyama S, Matsumura R, Kawakami A, Hayashi N, Abreu G, Yavuz S, Lindholm C, Al-Mossawi H, Takeuchi T. The long-term safety and tolerability of anifrolumab for patients with systemic lupus erythematosus in Japan: TULIP-LTE subgroup analysis. Mod Rheumatol 2024; 34:720-731. [PMID: 37706527 DOI: 10.1093/mr/road092] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/29/2023] [Accepted: 09/09/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVES Evaluate the long-term safety and tolerability of anifrolumab 300 mg, alongside standard therapy, in patients from Japan with systemic lupus erythematosus (SLE) in the TULIP-LTE trial (NCT02794285). METHODS TULIP-LTE was a 3-year, randomized, double-blind, placebo-controlled long-term extension (LTE) of the TULIP trials. The primary safety outcome included serious adverse events (SAEs) and AEs of special interest (AESIs) during the LTE period. Exploratory efficacy outcomes included SLE Disease Activity Index 2000 (SLEDAI-2 K) scores and glucocorticoid use. We performed a post hoc subgroup analysis of patients who enrolled in Japan. RESULTS Exposure-adjusted incidence rates of SAEs during the LTE and follow-up for patients receiving anifrolumab 300 mg (n = 21) were 8.7 per 100 patient-years; AESIs included influenza (6.9) and herpes zoster (3.5). One of three patients receiving placebo had an SAE (13.9). One patient per group discontinued due to an AE. There were no deaths. During the TULIP + LTE period, patients receiving anifrolumab 300 mg (n = 24) had sustained reduction from baseline in mean SLEDAI-2 K scores and cumulative glucocorticoid dosage. CONCLUSIONS Anifrolumab 300 mg showed a favourable benefit-risk profile for the long-term treatment of adult patients with moderate to severe SLE from Japan, with safety, tolerability, and efficacy profiles consistent with the overall population.
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Affiliation(s)
- Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology, and Nephrology, Hokkaido University, Sapporo, Japan
| | - Masato Okada
- Immuno-Rheumatology Center, St Luke's International Hospital, Tokyo, Japan
| | - Tomoya Miyamura
- Department of Internal Medicine and Rheumatology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Tomonori Ishii
- Department of Hematology and Rheumatology, Tohoku University Hospital, Miyagi, Japan
| | - Susumu Nishiyama
- Rheumatic Disease Center, Kurashiki Medical Center, Kurashiki, Japan
| | - Ryutaro Matsumura
- Department of Rheumatology, National Hospital Organization, Chiba-East Hospital, Chiba, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Gabriel Abreu
- Biometrics, Late Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Sule Yavuz
- Clinical Development, Late Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, United States of America
| | - Catharina Lindholm
- Clinical Development, Late Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Hussein Al-Mossawi
- Clinical Development, Late Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Tsutomu Takeuchi
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, and Saitama Medical University, Saitama, Japan
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He X, Zhu X, Tang Z, Gairy K, Juliao P, Wu Z, Han S. Hospital Healthcare Resource Utilization and Associated Hospital Costs of Patients With Lupus Nephritis in China: A National Administrative Claim Database Study. Value Health Reg Issues 2024; 43:101001. [PMID: 38850589 DOI: 10.1016/j.vhri.2024.101001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 02/08/2024] [Accepted: 03/11/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVES Assess hospital healthcare resource utilization (HCRU) and associated hospital costs of patients with lupus nephritis (LN) in China and compare these outcomes with a systemic lupus erythematosus (SLE) cohort (SLE with/without LN) as well as exploring the effect of end-stage kidney disease (ESKD). METHODS This retrospective administrative claims-based analysis identified patients with SLE and SLE with LN from China using diagnosis codes and keywords. Patients with LN were subcategorized by presence of ESKD. Outcomes included all-cause and disease-specific HCRU (defined as healthcare visits including inpatient and outpatient visits) and medical costs (in 2022 US dollars). RESULTS In total, 3645 patients with SLE were included, of whom 404 (11%) had LN. Among those with LN, 142 (35%) had ESKD. Median (interquartile range) all-cause healthcare visits per patient per month (PPPM) was significantly greater for patients with LN (2.08 [4.01]) vs SLE (0.92 [1.64]; P < .0001). Patients with LN and ESKD (3.00 [4.18]) had numerically more all-cause healthcare visits PPPM compared with LN patients without ESKD (1.50 [3.45]). Median all-cause costs PPPM were significantly greater among patients with LN ($287.46 [477.15]) vs SLE ($113.09 [267.39]; P < .0001) and numerically higher for patients with LN and ESKD ($466.29 [958.90]) vs LN without ESKD ($223.50 [319.56]). CONCLUSIONS Chinese patients with LN had greater HCRU and hospital healthcare costs compared with the general SLE cohort. This burden was higher for those with ESKD. These data highlight the substantial HCRU among patients with LN in China, especially those with ESKD, suggesting the need for early diagnosis and timely management of LN to mitigate the economic burden.
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Affiliation(s)
- Xin He
- Value Evidence and Outcomes, GSK, Shanghai, China
| | - Xiaochen Zhu
- International Research Center for Medicinal Administration, Peking University, Beijing, China; Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University, Beijing, China
| | - Zhiliu Tang
- Value Evidence and Outcomes, GSK, Shanghai, China
| | - Kerry Gairy
- Value Evidence and Outcomes, GSK, Brentford, England, UK
| | | | - Zongxi Wu
- Data Statistics Department, Beijing Brainpower Pharma Consulting Co. Ltd, Beijing, China
| | - Sheng Han
- International Research Center for Medicinal Administration, Peking University, Beijing, China; Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University, Beijing, China.
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Elsisi GH, Joe AY, Zain MM, Yusoof HM, Teh CL, Mohd AB, Khor XT, Isa LBM. Economic burden of systemic lupus erythematosus in Malaysia. J Med Econ 2024; 27:46-55. [PMID: 38468479 DOI: 10.1080/13696998.2024.2316537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/06/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Our cost-of-illness (COI) model adopted the perspective of both payer and society over a time horizon of 5 years to measure the economic burden of systemic lupus erythematosus (SLE) in Malaysia. METHODOLOGY Our COI model utilized a prevalence-based model to estimate the costs and economic consequences of SLE in Malaysia. The clinical parameters were obtained from published literature and validated using the Delphi panel. Direct and indirect medical costs were measured, including disease management, transient events, and indirect costs. One-way sensitivity analysis was also performed. RESULTS The number of target Malaysian patients with SLE in the COI model was 18,121. At diagnosis, the numbers of SLE patients with mild, moderate, and severe phenotypes were 2,582, 13,897, and 1,642, respectively. The total SLE cost in Malaysia over 5 years from both payer and society perspectives was estimated at MYR 678 million and 2 billion, respectively. The results showed a considerable cost burden due to productivity losses resulting from SLE-related morbidity and mortality. Over a 5-year time horizon, the costs per patient per year from the payer and society perspectives were MYR 7,484 ($4766) and 24,281($15,465), respectively. CONCLUSION Our study demonstrated the substantial economic burden of SLE in Malaysia over a time horizon of 5 years. It affects adults of working age, in addition to the costs of SLE management and its consequences, such as flares, infection, and organ damage. Our COI model indicated that disease management costs among patients with higher disease severity were higher than those among patients with a mild phenotype. Hence, more attetion should be paid to limiting the progression of SLE and the occurrence of flares, with the need for further economic evaluation of novel treatments that could lead to better outcomes.
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Affiliation(s)
- Gihan Hamdy Elsisi
- HTA Office, LLC, Cairo, Egypt
- Health Economics, Faculty of Economics, American University in Cairo, Cairo, Egypt
| | - Ang Yu Joe
- Selayang Hospital, Lebuhraya Selayang - Kepong, Selangor, Malaysia
| | | | | | - Cheng Lay Teh
- Hospital Umum Sarawak, Jalan Hospital, Sarawak, Malaysia
| | - Asmah Binti Mohd
- Tuanku Ja'afar Hospital, Jalan Rasah, Bukit Rasah, Negeri Sembilan, Malaysia
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Wang X, Li M, Zeng X, Wang Q. Lenalidomide for systemic lupus erythematosus with refractory cutaneous eruptions. Rheumatology (Oxford) 2023; 62:e293-e294. [PMID: 36943383 DOI: 10.1093/rheumatology/kead116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/06/2023] [Accepted: 02/20/2023] [Indexed: 03/23/2023] Open
Affiliation(s)
- Xiaoqi Wang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
- Department of Rheumatology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Qian Wang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science and Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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Pichaiwong W, Lawanaskol S, Phinyo P, Kitumnuaypong T. The efficacy of induction treatment in Thai patients with lupus nephritis: Observational cohort analysis. Lupus 2023; 32:444-452. [PMID: 36602394 DOI: 10.1177/09612033221149874] [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] [Indexed: 01/06/2023]
Abstract
BACKGROUND For active proliferative lupus nephritis (LN), intravenous cyclophosphamide (IVCYC) is a standard therapy whereby mycophenolate mofetil (MMF) is less effective than IVCYC, according to the clinical trials in non-Asians. In this observational study, the clinical outcomes will be compared among Thai patients. METHODS We had analyzed 93 adult patients who underwent a renal biopsy for active proliferative LN confirmation between January 2013 and June 2021. The assessment of the response outcomes compared the induction treatment of IVCYC versus MMF. The primary endpoint had achieved complete remission (CR) at 24 weeks, while the secondary endpoint is overall remission (OR) and urine protein creatinine ratio (UPCR) changed over time. RESULTS 93 LN patients were separated into two groups; 40 in IVCYC and 53 in MMF. In the 24th week, based on unadjusted analysis, patient had achieved CR 20.0% of IVCYC, whereas 28.3% of MMF had achieved CR. Unadjusted CR Risk difference was -0.08 (95% CI -0.26, -0.09, p-value = 0.351) and the adjusted CR risk difference was -0.19 (95% CI -0.42, 0.04, p-value = 0.098). The unadjusted OR risk difference was -0.06 (95% CI -0.26, 0.14, p-value = 0.553) while adjusted OR risk difference was -0.24 (95% CI -0.50, 0.02, p-value = 0.067). Unadjusted UPCR mean was -0.29 (95% CI -0.77, 0.17, p-value = 0.210) and adjusted UPCR mean was -0.27 (95% CI -0.88, 0.32, p-value = 0.366). CONCLUSIONS The induction treatment with either IVCYC or MMF had similar efficacy in Thai LN patients. The decision of treatment should be taken by applying an individualized therapeutic strategy and balancing risks, costs, and benefits.
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Affiliation(s)
- Warangkana Pichaiwong
- Nephrology Division, Department of Medicine, 54781Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | | | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, 37686Chiang Mai University, Chiang Mai, Thailand
| | - Tasanee Kitumnuaypong
- Rheumatology Division, Department of Medicine, 54781Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
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Issayeva BG, Aseeva EA, Saparbayeva MM, Issayeva SM, Kulshymanova MM, Kaiyrgali SM, Amanzholov AS, Bizhanova MP, Kalykova MB, Solovyev SK, Akhtaeva NS. Features of clinical manifestations, course, outcomes and health related quality of life in patients with systemic lupus erythematosus in the Republic of Kazakhstan. RHEUMATOLOGY SCIENCE AND PRACTICE 2022. [DOI: 10.47360/1995-4484-2022-602-611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective – to evaluate the features of clinical manifestations, course, outcomes and quality of life related to health in patients with systemic lupus erythematosus in the Republic of Kazakhstan.Patients and methods. The study included 102 patients with systemic lupus erythematosus (SLE) with a reliable diagnosis according to SLICC (2012). Disease activity was assessed by the SLEDAI 2K index, organ damage (IOD) by SLICC/ACR (2000). Statistical processing was carried out using SPSS 13 software (IBM Corp., USA). Variables with a parametric distribution are presented as М±SD, nonparametric – as a median (Me) [25th; 75th percentile].Results and discussion. The cohort was dominated by female patients (98%), Asians (83.33%), young patients (33.85±10.58 years) with a disease duration of 5 [2; 9] years with high (30.8%) and very high (39.2%) degree of activity (SLEDAI-2K – 17.64±8.80 points). The debut of the disease was in 18.6% of patients in adolescence, it was characterized by an unfavorable course. Clinical manifestations of the disease: skin lesions (acute active and chronic forms) (98%), joints (79.4%), non-scarring alopecia (75.5%), neuropsychiatric disorders (49%), mucous membranes (46.1%), hematological (54.9%) and immunological disorders (100%). IOD: low – in 20.6%, medium – in 59.8%, high – in 9.8% of patients, 0 – in 9.8%, Risk factors for poor outcome were in 93.1% of patients. Assessment of health-related quality of life (HRQOL) in SLE patients showed a significant decrease on all scales. Correction of the treatment program, taking into account the factors of adverse outcome (FRNI), consisted in strengthening therapy with the inclusion of genetically engineered biological drugs (GEBP).Conclusion. SLE is a socially significant disease in Kazakhstan with a high incidence rate (101%) over 10 years (2009–2018). The cohort of SLE patients is dominated by young people, females. The duration of the disease is up to 5 years with a delayed verification of the diagnosis of SLE. Organ damage is already in the onset of the disease and the presence of FRNI of the disease in 93.1% of patients, which indicates the severity of the course, which requires early diagnosis and active involvement of pathogenetic treatment, including GEBD.
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Affiliation(s)
| | - E. A. Aseeva
- V.A. Nasonova Research Institute of Rheumatology
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Sada K, Kurita N, Noma H, Matsuki T, Quasny H, Levy RA, Jones-Leone AR, Gairy K, Yajima N. MOONLIGHT study: the design of a comparative study of the effectiveness of belimumab in patients with a history of lupus nephritis from the post-Marketed effectiveness of belimumab cOhOrt and JapaN Lupus NatIonwide reGistry (LUNA) coHorT. Lupus Sci Med 2022; 9:9/1/e000746. [PMID: 37017254 PMCID: PMC9438087 DOI: 10.1136/lupus-2022-000746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/23/2022] [Indexed: 11/18/2022]
Abstract
Introduction Lupus nephritis (LN) is more prevalent in patients with SLE of Asian ethnicity than in Caucasian patients. Belimumab became available in Japan in 2017 to treat patients with SLE, including those with LN. In the BLISS-LN trial (NCT01639339), belimumab showed a favourable effect on renal outcomes when combined with standard therapy (ST) starting at the induction treatment phase for active LN, but real-world effectiveness of belimumab in LN has not been extensively studied. Here we describe the protocol for the MOONLIGHT (post-Marketed effectiveness of belimumab cOhOrt and JapaN Lupus NatIonwide ReGistry (LUNA) coHorT) study, which will use data from a Japan postmarketing surveillance study and the Lupus Registry of Nationwide Institutions (LUNA) to evaluate the real-world effectiveness of belimumab plus ST versus ST alone in patients with a history of active LN who are not in the induction phase. Methods and analysis This multicentre, retrospective, observational study (GSK Study 214710) will enrol adults with SLE and a history of active LN, holding ≥3 years of complete follow-up data from the initiation of belimumab (no continuous treatment required). Data for patients with belimumab plus ST treatment (postmarketing registry data, belimumab cohort) will be compared with those for patients with ST only treatment (LUNA data, comparison cohort). Patients who discontinue/initiate belimumab after the start of the follow-up may be included in the comparison/belimumab cohort, respectively. The primary endpoint will be the occurrence of renal flares, for which belimumab’s effectiveness will be estimated using a marginal structural model to consider time-dependent treatment and confounding factors. Secondary endpoints will include change in corticosteroid dose, renal disease activity, extrarenal disease activity, disease severity/activity biomarkers, LN class changes, end-stage kidney disease events and hospitalisations. Ethics and dissemination This study will be conducted according to the Declaration of Helsinki and the local ethical guidelines. Findings will be submitted to peer-reviewed journals and presented at scientific meetings.
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Affiliation(s)
- Kenei Sada
- Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Noriaki Kurita
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Taizo Matsuki
- Value Evidence and Outcomes Division, GSK K.K, Tokyo, Japan
| | - Holly Quasny
- Clinical Sciences, GSK, Research Triangle Park, North Carolina, USA
| | - Roger A Levy
- Global Medical Affairs, GSK, Collegeville, Pennsylvania, USA
| | | | - Kerry Gairy
- Value Evidence and Outcomes Division, GSK, Brentford, UK
| | - Nobuyuki Yajima
- Division of Rheumatology, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
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Ullah S, Haroon M, Hashmi F, Tayyab Z, Javed S. A Prospective Follow-Up Study on the Disease Course and Predictors of Poor Outcomes in a Random Population-Based Cohort of Newly Diagnosed Lupus Patients. Cureus 2022; 14:e27430. [PMID: 36051712 PMCID: PMC9420196 DOI: 10.7759/cureus.27430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/05/2022] Open
Abstract
Background and objective Systemic lupus erythematosus (SLE) is one of the most devastating systemic autoimmune connective tissue diseases. There is a paucity of prospective data on Pakistani SLE patients, and in this prospective study, we aimed to investigate the disease course, clinical outcomes, and the predictors of poor outcomes in a random population-based cohort of newly diagnosed SLE patients (diagnosed within the last one year). Methods This was a prospective observational study carried out in the rheumatology department of the Fatima Memorial Hospital, Lahore. Lupus patients are regularly reviewed in our dedicated lupus clinic every one to three months. For the purpose of this study, a focus group of newly diagnosed patients (diagnosed within the last one year) attending our lupus clinic was identified and prospectively followed up for 12 months. A wide range of demographical and clinical parameters was recorded. The association of clinical variables with the progressive disease was determined using univariate and multivariate logistic regressions. Results Prospective data of 89 newly diagnosed SLE patients regularly attending our dedicated lupus clinic were reviewed. During the study period, (January 2021 through January 2022), these patients had multiple visits overall - median: five, minimum: three, and maximum: nine visits [interquartile range (IQR) 4-7]. All 89 patients had completed one year of follow-up. Of note, 46% of the cohort was noted to have an ongoing active disease during the majority of visits in the study period. On multiple logistic regression analysis, there was a significant association between ongoing active disease ("progressors") and low education status [odds ratio (OR): 2.81, 95% confidence interval (CI): 1.01-7.76, p=0.046], stress at home (OR: 5.8, 95% CI: 2.13-15.8, p=0.001), and hematologic manifestations (OR: 3.0, 95% CI: 1.08-8.32, p=0.03). Conclusions Almost half of our cohort of lupus patients demonstrated active disease manifestations throughout the one-year prospective follow-up, and these were found to be associated with low education status, stress at home, and hematological manifestations.
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Damara I, Winston K, Maulida F, Ariane A. Factors Associated With Candidiasis in Systemic Lupus Erythematosus Patients in Cipto Mangunkusumo National General Hospital: A Single-Center Case-Control Study. Cureus 2022; 14:e27107. [PMID: 36000133 PMCID: PMC9391667 DOI: 10.7759/cureus.27107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Infection has been a major cause of morbidity and mortality in systemic lupus erythematosus (SLE) patients. One of the infections encountered in SLE patients is candidiasis. Therefore, we aimed to conduct a case-control study to explore the risk factors associated with candidiasis in SLE patients in our center. Methods: Medical records of 20 SLE patients with fungal infection were obtained, and a case-control study was conducted with an age and sex-matched control group of 20 patients. Data were obtained from the Cipto Mangunkusumo National General Hospital. SLE confirmatory diagnosis was based on Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) 2012 criteria. Patients with comorbidities of various chronic diseases (diabetes, HIV, and chronic kidney disease) were excluded. Statistical analysis was conducted using the Mann-Whitney U test with statistical significance defined as a p-value < 0.05. Result: Based on the analysis, a maximum corticosteroid dose of 24 (4-250) mg/day for the last one year was associated with the development of fungal infection (p = 0.047). Lower absolute lymphocyte count (748 cells/mm³ versus 1635 cells/mm³) was also associated with the occurrence of candidiasis in SLE patients (p = 0.008). Conclusion: Physicians should be aware that corticosteroid use in SLE patients may cause candidiasis. Monitoring of maximum corticosteroid dose and absolute lymphocyte count is important to help prevent candidiasis. Patients should also be educated regarding the risk of candidiasis from corticosteroid use.
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Tan J, Liew A, Koh D. Clinical outcomes and performance indicators of patients with Kidney Failure and Acute Kidney Injuries in ASEAN countries. Nephrology (Carlton) 2022; 27:739-752. [PMID: 35661340 DOI: 10.1111/nep.14070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/29/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This review article reports clinical outcomes and performance indicators of patients with Kidney Failure (KF) and Acute Kidney Injuries (AKI) in Association of South East Asian Nations (ASEAN) countries. METHODOLOGY ASEAN data, segregated by income status, from national registries and literature were collated, compared and benchmarked against international references. RESULTS The national incidence and prevalence of treated KF ranged from 172-479 per million population (pmp) and 36-2255 pmp respectively. Brunei (79%), Malaysia (66%) and Singapore (66%) had world-leading proportions of diabetes-related KF. Haemodialysis (HD), Peritoneal Dialysis (PD) and transplant accounted for 68-100%, 0-27% and 0-18% of all Kidney Failure Replacement Therapy respectively. Transplant patient survival were superior with 90-93% at five years and 71-90% at 10 years, compared to PD (44-54%) and HD (53-64%) at five years. Higher-income countries were able to achieve good anaemia control, HD and PD adequacy targets, whilst usage of arteriovenous fistula in HD varied from 70-85%. Acute Kidney Injury (AKI) rates ranged from 24.2-49.2% of high-dependency admissions. Lower incidences of PD peritonitis and HD Catheter-related Bloodstream Infections; and PD-favouring quality-of-life were evident in higher-income countries. CONCLUSION ASEAN has a challenging burden of kidney disease, with extremely high incidence, prevalence, DM-related KF and AKI rates. The magnitude of the prevailing problem calls for the creation of a regional society under the auspices of ASEAN with a shared perspective of universal, equitable and charitable access to quality renal care; consistent with the founding premises and healthcare initiatives of ASEAN. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jackson Tan
- Department of Nephrology, Ripas Hospital / Universiti Brunei Darussalam, Brunei Darussalam
| | - Adrian Liew
- The Kidney & Transplant Practice, Mount Elizabeth Novena Hospital, Singapore
| | - David Koh
- NUS Saw Swee Hock School of Public Health, Singapore
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Revisited Cyclophosphamide in the Treatment of Lupus Nephritis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8345737. [PMID: 35707391 PMCID: PMC9192236 DOI: 10.1155/2022/8345737] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 05/09/2022] [Indexed: 11/18/2022]
Abstract
Lupus nephritis (LN) is the most common serious complication of systemic lupus erythematosus (SLE). The pathogenesis of LN is complex, and the majority causes of LN are the renal deposition of circulating or/and in situ-formed immune complexes. These immune complexes trigger glomerular and tubulointerstitial inflammation, which finally leads to proteinuria and loss of renal function. Despite the emergence of new biological agents, cyclophosphamide (CY), an alkylating agent, is still the first-line drug widely used to treat patients with severe LN. In this review, we outline the application history, molecular structure, and pharmacokinetics of CY in the treatment of LN. We also detail its latest known immunopharmacological mechanisms, with a focus on supplemental regulation and inhibition of CD4 and CD8 positive T cells, differences in the use of various guidelines, and the combination with other drugs. The side effects of CY are also mentioned in this review.
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Hikmah Z, Endaryanto A, Ugrasena IDG, Rahaju AS, Arifin S. Nigella sativa L. as immunomodulator and preventive effect on renal tissue damage of lupus mice induced by pristane. Heliyon 2022; 8:e09242. [PMID: 35450390 PMCID: PMC9018149 DOI: 10.1016/j.heliyon.2022.e09242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/27/2021] [Accepted: 03/31/2022] [Indexed: 11/01/2022] Open
Abstract
Introduction Objective Methods Results Conclusion
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13
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Zheng Z, Zhang H, Peng X, Zhang C, Xing C, Xu G, Fu P, Ni Z, Chen J, Xu Z, Zhao MH, Li S, Huang X, Miao L, Chen X, Liu B, He Y, Li J, Liu L, Kadeerbai H, Liu Z, Liu Z. Effect of Tacrolimus vs Intravenous Cyclophosphamide on Complete or Partial Response in Patients With Lupus Nephritis: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e224492. [PMID: 35353167 PMCID: PMC8969066 DOI: 10.1001/jamanetworkopen.2022.4492] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
IMPORTANCE Lupus nephritis (LN) is typically treated with intravenous cyclophosphamide (IVCY), which is associated with serious adverse effects. Tacrolimus may be an alternative for initial treatment of LN; however, large-scale, randomized clinical studies of tacrolimus are lacking. OBJECTIVE To assess efficacy and safety of tacrolimus vs IVCY as an initial therapy for LN in China. DESIGN, SETTING, AND PARTICIPANTS This randomized (1:1), open-label, parallel-controlled, phase 3, noninferiority clinical trial recruited patients aged 18 to 60 years with systemic lupus erythematosus and LN class III, IV, V, III+V, or IV+V primarily from outpatient settings at 35 centers in China. Inclusion criteria included body mass index of 18.5 or greater to less than 27, 24-hour urine protein of 1.5 g or greater, and serum creatinine of less than 260 μmol/L. Of 505 patients screened, 191 failed screening (163 ineligible, 25 withdrawn consent, and 3 other reasons). Overall, 314 were randomized. The first patient was enrolled March 10, 2015, and the study finished September 13, 2018. The follow-up period was 24 weeks. Data were analyzed from December 2019 to March 2020. INTERVENTIONS Oral tacrolimus (target trough level, 4-10 ng/mL) or IVCY for 24 weeks plus prednisone. MAIN OUTCOMES AND MEASURES Complete or partial response rate at week 24 (prespecified). RESULTS A total of 314 patients were randomized (158 [50.3%] to tacrolimus and 156 [49.7%] to IVCY). Overall, 299 patients (95.2%) were treated (tacrolimus group, 157 [52.5%]; IVCY group, 142 [47.5%]). Baseline demographic and clinical characteristics were generally similar between groups (mean [SD] age, 34.2 [9.5] years; 262 [87.6%] female). Tacrolimus was found to be noninferior to IVCY for LN response at week 24. There was a complete or partial response rate of 83.0% (117 of 141 patients) in the tacrolimus group and 75.0% (93 of 124 patients) in the IVCY group (difference, 7.1%; 2-sided 95% CI, -2.7% to 16.9%; lower limit of 95% CI greater than -15%). At week 24, least-square mean change in Systemic Lupus Erythematosus Disease Activity Index score was -8.6 with tacrolimus and -6.4 with IVCY (difference, -2.2; 95% CI, -3.1 to -1.3). Changes in other immune parameters and kidney function were generally similar between groups. Serious treatment-emergent adverse events (TEAEs) were reported in 29 patients in the tacrolimus group (18.5%) and 35 patients in the IVCY group (24.6%). Most common serious study drug-related TEAEs were infections (14 [8.9%] and 23 [16.2%], respectively). Seven patients in each group withdrew due to AEs. CONCLUSIONS AND RELEVANCE In this study, oral tacrolimus appeared noninferior to IVCY for initial therapy of active LN, with a more favorable safety profile than IVCY. Tacrolimus may be an alternative to IVCY as initial therapy for LN. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02457221.
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Affiliation(s)
- Zhaohui Zheng
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haitao Zhang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China
| | - Xiaomei Peng
- Department of Nephrology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Chun Zhang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Changying Xing
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Gang Xu
- Department of Nephrology, Tongji Hospital affiliated with Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ping Fu
- Renal Division, Department of Medicine, West China Hospital of Sichuan University, Kidney Research Institute, Chengdu, Sichuan, China
| | - Zhaohui Ni
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhonggao Xu
- Department of Nephrology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Ming-hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China, and Peking-Tsinghua Center for Life Sciences, Beijing, China
| | - Shaomei Li
- Department of Nephrology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiangyang Huang
- Department of Nephrology, Liuzhou Worker’s Hospital, Liuzhou, Guangxi, China
| | - Lining Miao
- Department of Nephrology, Second Hospital, Jilin University, Changchun, Jilin, China
| | - Xiaonong Chen
- Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bicheng Liu
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, Jiangsu, China
| | - Yongcheng He
- Department of Nephrology, Shenzhen Hengsheng Hospital, Shenzhen, Guangdong, China
| | - Jing Li
- Department of Nephrology, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | | | | | - Zhangsuo Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhihong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China
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Huang X, Zhang Q, Zhang H, Lu Q. A Contemporary Update on the Diagnosis of Systemic Lupus Erythematosus. Clin Rev Allergy Immunol 2022; 63:311-329. [DOI: 10.1007/s12016-021-08917-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 12/11/2022]
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Souza RRD, Marcon SS, Teston EF, Barreto MDS, Reis PD, Cecilio HPM, Marquete VF, Ferreira PC. From diagnosis to complications: experiences of those who live with systemic lupus erythematosus. Rev Bras Enferm 2022; 75:e20200847. [DOI: 10.1590/0034-7167-2020-0847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/19/2021] [Indexed: 08/22/2023] Open
Abstract
ABSTRACT Objective: To understand how people with lupus experience the diagnosis and how they deal with complications arising from the disease. Method: Qualitative study, whose data were collected between February and July 2019, through semi-structured interviews with 26 individuals and submitted to content analysis. Results: Three categories emerged that show illness from lupus as a difficult experience, permeated by sadness, fear and suffering, which, in addition to being linked to society’s lack of knowledge about the disease, negatively impacts the lives of those who experience it. Furthermore, they show that the time of living with the disease favors the development of self-care strategies and greater therapeutic adherence and, consequently, longer periods of disease remission. Considerations: More disclosure about the disease and its implications in the daily lives of those affected is essential, culminating in greater understanding of family, friends and colleagues and improvements in health care and quality of life for these people.
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Lee MH, Koh JWH, Ng CH, Lim SHH, Cho J, Lateef A, Mak A, Tay SH. A meta-analysis of clinical manifestations in asian systemic lupus erythematous: The effects of ancestry, ethnicity and gender. Semin Arthritis Rheum 2021; 52:151932. [PMID: 34996626 DOI: 10.1016/j.semarthrit.2021.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 11/17/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Systemic lupus erythematosus (SLE) in Asians is a unique patient group that has been thought to present with more severe organ involvement in comparison to their non-Asian counterparts. We set out to perform a meta-analysis to compare clinical manifestations between ancestries, with a focus on Southeast Asian ethnicities and gender. MATERIALS AND METHODS A cross-sectional study was performed in conjunction with a meta-analysis to identify differences in prevalences of SLE clinical manifestations. Searches were conducted on Medline for articles comparing between: (i) Asian and non-Asian ancestry; (ii) Southeast Asian ethnicities (Chinese, Malay and Indian); and (iii) male and female Asians. Using random effects model, effect sizes as odd ratios were pooled with DerSimonian and Laird's model. RESULTS A total of 13 articles were identified and pooled together with our study for this meta-analysis. Comparing among patients of Asian with Non-Asian/European ancestries, no significance difference was found in severe organ manifestations such as renal and neurological involvement [odds ratio (OR): 1.398, p= 0.320 and OR: 1.224, p= 0.526 respectively]. There was significantly greater proportion of Asian SLE patients with thrombocytopenia compared to non-Asian SLE. Chinese SLE patients were less likely to have oral ulcers compared to Indian SLE patients. Lastly, Asian male SLE patients had greater incidence of renal involvement and thrombocytopenia compared to Asian female SLE patients. CONCLUSIONS Severe SLE manifestations such as renal and neurological involvement were not significantly more frequent in Asian SLE compared to non-Asian/European SLE in this analysis.
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Affiliation(s)
- Ming Hui Lee
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore
| | - Jeffery Wei Heng Koh
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sandy H H Lim
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore
| | - Jiacai Cho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Rheumatology, Department of Medicine, National University Hospital, Singapore
| | - Aisha Lateef
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Rheumatology, Department of Medicine, National University Hospital, Singapore; Department of Medicine, Woodlands Health Campus, Singapore
| | - Anselm Mak
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Rheumatology, Department of Medicine, National University Hospital, Singapore
| | - Sen Hee Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Rheumatology, Department of Medicine, National University Hospital, Singapore.
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Selvananda S, Kan SL. Performance of the 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus in a multiethnic Malaysian cohort. Int J Rheum Dis 2021; 25:131-139. [PMID: 34939743 DOI: 10.1111/1756-185x.14269] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 12/19/2022]
Abstract
AIM To evaluate the performance of the 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for systemic lupus erythematosus (SLE) in a multi-ethnic Malaysian cohort and to compare it against the Systemic Lupus International Collaborating Clinics (SLICC) 2012 and ACR 1997 criteria. METHOD We conducted a retrospective observational study of 205 patients with a diagnosis of SLE and 100 controls who formed the validation cohort. The sensitivity and specificity of the three classification criteria were evaluated and a further sub-analysis was performed in patients with early disease and among the various ethnicities. RESULTS The sensitivities and specificities of the three classification criteria are as follows: EULAR/ACR (90.8%; 94%), SLICC 2012 (96.1%; 94%), and ACR 1997 (82%; 96%). Among patients with early disease, the sensitivity of the SLICC 2012 was higher than that of EULAR/ACR and ACR 1997 (98% vs 94% and 86%); however, the specificity of EULAR/ACR and ACR 1997 were similar (95.2%) and higher than the SLICC 2012 (93.5%). The SLICC 2012 had higher sensitivity than that of the EULAR/ACR among the Malays (94% vs 90%), Chinese (98% vs 90%), and Indians (100% vs 95%). The specificity of the EULAR/ACR and SLICC 2012 were similar in the Malay and Chinese (93.3% each, and 92% vs 94.6%). CONCLUSION The EULAR/ACR performed well in our cohort. The EULAR/ACR and SLICC 2012 showed higher sensitivity than the ACR 1997, and the EULAR/ACR showed similar specificity to the ACR 1997 and SLICC 2012 overall, in early disease, and across the different ethnicities.
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Affiliation(s)
- Shakira Selvananda
- Rheumatology Unit, Department of Internal Medicine, Penang General Hospital, Penang, Malaysia
| | - Sow Lai Kan
- Rheumatology Unit, Department of Internal Medicine, Penang General Hospital, Penang, Malaysia
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Zhou A, Mao K, Liu G, Li J, Lin X. lncRNA MALAT-1 Predicts Prognosis of Patients with Systemic Lupus Erythematosus. AKTUEL RHEUMATOL 2021. [DOI: 10.1055/a-1527-1197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Objective To evaluate the association of MALAT-1 and the prognosis of patients with systemic lupus erythematosus (SLE).
Materials and Methods A total of 87 SLE patients and 50 healthy controls were recruited. The expression levels of MALAT-1 were measured by quantitative PCR at baseline. Multivariate Cox regression analysis was performed to assess the association of MALAT-1 levels with survival after adjusting for potential confounding factors.
Results The MALAT-1 levels in patients with SLE were significantly higher compared with healthy controls (p<0.01). The 10-year survival of patients with a higher MALAT-1 level was significantly lower than that of patients with a lower MALAT-1 level (HR=5.54; 95% CI: 1.49–20.55; p=0.01). Multivariate Cox regression indicated that the MALAT-1 level was significantly associated with a risk of mortality (HR=10.02, 95% CI: 1.14–88.14, p=0.04).
Conclusion The expression levels of MALAT-1 may be a promising biomarker for evaluating the prognosis of SLE patients.
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Affiliation(s)
- Aihong Zhou
- Department of Rheumatology immunology, The Second Affiliated Hospital of Shandong First Medical University, Tai’an, China
| | - Kunyun Mao
- Department of Nephrology and Rheumatology, Dongping County People Hospital of Tai’an, Dongping, China
| | - Guoqiang Liu
- Department of Emergency, The Central Hospital of Tai’an, Tai’an, China
| | - Jun Li
- Department of Emergency, Coal Taishan sanatorium of Shandong Province (Shandong Tai’an Coal Mine Hospital), Dongping, China
| | - Xia Lin
- Department of Nephrology and Rheumatology, Dongping County People Hospital of Tai’an, Dongping, China
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Al-Adhoubi NK, Al-Balushi F, Al Salmi I, Ali M, Al Lawati T, Al Lawati BSH, Abdwani R, Al Shamsi A, Al Kaabi J, Al Mashaani M, Krishna Jha D, Sayed S, Al-Araimi T, Liyanage P, Al Shirawi A, Al Wahshi HA. A multicenter longitudinal study of the prevalence and mortality rate of systemic lupus erythematosus patients in Oman: Oman Lupus Study. Int J Rheum Dis 2021; 24:847-854. [PMID: 34058079 DOI: 10.1111/1756-185x.14130] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/02/2021] [Accepted: 05/02/2021] [Indexed: 02/05/2023]
Abstract
AIM This study is a longitudinal multicenter study which aims to find the prevalence, the demographic data, survival and mortality rates of patients with systemic lupus erythematosus (SLE) in Oman. METHOD All Omani patients, pediatrics and adults diagnosed with SLE, who fulfill either the 1997 American College of Rheumatology or Systemic Lupus International Collaborating Clinics classifications criteria for SLE were included from January 2006 till February 2020. RESULTS In total 1160 patients were included in this cohort. Data analysis showed that patient's ages ranged from 2-82 years with female predominance and female-to-male ratio of 7:1 (87.7% female,12.3% male). The mean prevalence of SLE among different age groups was 38.8 (range 5-63 per 100 000 inhabitants). The mortality rate was found to be 5%. Male patients had significantly higher mortality rate than females (7.6% vs 5.4%, P value = .04). Sepsis was the commonest cause of mortality (34%). The coexistence of systemic sclerosis correlates significantly with death (P = .002). Survival analysis in our data showed 5, 10, 20, 40-year survival rates of 100%, 100%, 99% and 90% respectively for antinuclear antibody (ANA) positive patients and lower survival rate for ANA negative patients with 5,10, 20, 40-year survival rates of 100, 99%, 99% and 75%, respectively. CONCLUSION This study showed that the mean prevalence of SLE in Oman to be 38.8 (range 5-63) per 100 000 inhabitants. The 40-year survival rate among patients with positive ANA was found to be 90%, while patients with negative ANA had worse survival outcomes.
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Affiliation(s)
- Nasra K Al-Adhoubi
- Rheumatology Unit, Royal Hospital, Muscat, Oman
- Internal Medicine, Oman Medical Specialty Board, Muscat, Oman
| | | | - Issa Al Salmi
- Internal Medicine, Oman Medical Specialty Board, Muscat, Oman
- Nephrology Department, Royal Hospital, Muscat, Oman
| | - Maha Ali
- Rheumatology Unit, Al Nahdha Hospital, Muscat, Oman
| | - Talal Al Lawati
- Adult Rheumatology Unit, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Reem Abdwani
- Paediatric Rheumatology Unit, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ali Al Shamsi
- Rheumatology Unit, Al Buraimi Hospital, Al Buraimi, Oman
| | - Juma Al Kaabi
- Rheumatology Unit, Al Buraimi Hospital, Al Buraimi, Oman
| | | | | | | | | | | | - Ali Al Shirawi
- Adult Rheumatology Unit, Sultan Qaboos University Hospital, Muscat, Oman
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Nimesh S, Ahmad MI, Dhama S, Kumar P, Akram M, Hasaroeih NEN. Systemic Lupus Erythematosus Disease: An Overview of the Clinical Approach to Pathogenesis, Diagnosis, and Treatment. BORNEO JOURNAL OF PHARMACY 2021. [DOI: 10.33084/bjop.v4i2.1950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The systemic lupus erythematosus (SLE), commonly known as Lupus, is a rare and complex multisystem autoimmune disease where one’s immune system is overactive, and the body attacks its organ systems. SLE is a historically old disease described already in antiquity; it is an example of a chronic disease with physical, psychological, financial, and social implications for individuals diagnosed. It has inspired medical and basic biological scientists that focus on molecular biology, basic immunology, immunopathology, clinical science, genetics, and epidemiology. The syndrome is real in its existence-although hidden behind obstacles, cumbersome for patients and clinicians, and rebellious for scientists. There is currently no cure for SLE. The goal of treatment is to ease symptoms. This article will review information on the general approach to SLE therapy, focusing on currently approved therapies and novel approaches that might be used in the future.
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Furie RA, Bruce IN, Dörner T, Leon MG, Leszczyński P, Urowitz M, Haier B, Jimenez T, Brittain C, Liu J, Barbey C, Stach C. Phase 2, Randomized, Placebo-Controlled Trial of Dapirolizumab Pegol in Patients with Moderate-to-Severe Active Systemic Lupus Erythematosus. Rheumatology (Oxford) 2021; 60:5397-5407. [PMID: 33956056 PMCID: PMC9194804 DOI: 10.1093/rheumatology/keab381] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/14/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate the dose–response, efficacy and safety of dapirolizumab pegol (DZP) in
patients with SLE. Methods Adults with moderately to severely active SLE (SLEDAI-2K score ≥6 and ≥1 BILAG A or ≥2
BILAG B domain scores), receiving stable CS (≤40 mg/day prednisone-equivalent),
antimalarial or immunosuppressant drugs were included. Patients with stable LN
(proteinuria ≤2 g/day) not receiving high-dose CS or CYC were permitted entry.
Randomized patients received placebo or i.v. DZP (6/24/45 mg/kg) and standard-of-care
(SOC) treatment every 4 weeks to week 24, after which patients received only SOC to week
48. The primary objective was to establish a dose–response relationship based on week 24
BILAG-Based Composite Lupus Assessment (BICLA) responder rates. Results All DZP groups exhibited improvements in clinical and immunological outcomes
vs placebo at week 24; however, BICLA responder rates did not fit
pre-specified dose–response models [best-fitting model
(Emax): P = 0.07]. Incidences of serious
treatment-emergent adverse events across DZP groups were low and similar to placebo.
Following DZP withdrawal, SLEDAI-2K, physician’s global assessment (PGA), BILAG, and
Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) scores stabilized;
BICLA and SLE Responder Index (SRI-4) responder rates declined (likely due to
interventions with disallowed escape medications), BILAG flares increased, and
immunologic parameters returned towards baseline. Conclusions Although the primary objective was not met, DZP appeared to be well tolerated, and
patients exhibited improvements across multiple clinical and immunological measures of
disease activity after 24 weeks relative to placebo. The potential clinical benefit of
DZP warrants further investigation.
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Affiliation(s)
| | - Ian N Bruce
- NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Trust, Manchester, UK.,Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Salido EO, Tee CA, Reyes PWC, Reyes HBM, Zamora GT, Tee ML. Self-Reported Symptoms in a Cohort of Rheumatoid Arthritis and Systemic Lupus Erythematosus during the COVID-19 Quarantine Period. Open Rheumatol J 2021. [DOI: 10.2174/1874312902115010016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background:
During the first three months of the COVID-19 pandemic in the Philippines, there was a supply shortage of hydroxychloroquine and methotrexate. Limited access to medication and the life changes resulting from the COVID-19 pandemic may predispose patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) to disease flares.
Objective:
This study aimed to investigate self-reported symptoms of disease flares among patients with rheumatoid arthritis or systemic lupus erythematosus during the COVID-19 pandemic.
Methods:
A total of 512 completed online surveys from patients with SLE or RA were collected. The data included sociodemographic characteristics, self-reported physical symptoms, health service utilization, and availability of hydroxychloroquine and methotrexate.
Results:
Seventy-nine percent of respondents had lupus, while 21% had RA. One-third of the cohort had contact with their attending physician during the two-month quarantine period prior to the survey. Eighty-two percent were prescribed hydroxychloroquine and 23.4% were prescribed methotrexate; but 68.6% and 65%, respectively, had “irregular” intake of these medicines due to unavailability. The current health status was reported as good by 66.2%; 24% had no symptoms during the two-week period prior to the survey. The most common symptoms experienced were joint pain (51%), muscle pain (35%), headache (26.8%), and skin rash (19.1%). Five percent had a combination of these four most common symptoms. Irregular supply of hydroxychloroquine among patients with SLE (n=323) was associated with more frequent occurrence of muscle pain (40.6% vs 27.9%, p=0.03) or rash (27.4% vs 11.7%, p<0.001). Irregular supply of methotrexate among RA patients prescribed hydroxychloroquine and methotrexate (n=36) was associated with more frequent occurrence of joint pains with or without swelling (73.9% vs 38.5%, p=0.04). Irregular supply of hydroxychloroquine was associated with less frequent occurrence of dizziness (0 vs 66.7%, p<0.001) among RA patients (n=18).
Conclusion:
In our cohort of RA and SLE, the majority reported at least one symptom that may indicate disease flare. There was a significant association between the irregular supply of hydroxychloroquine or methotrexate with the presence of muscle pain, rash, or joint pains during the 14-day period prior to the survey.
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Strufaldi FL, Menezes Neves PDMDM, Dias CB, Yu L, Woronik V, Cavalcante LB, Malheiros DMAC, Jorge LB. Renal thrombotic microangiopathy associated to worse renal prognosis in Lupus Nephritis. J Nephrol 2021; 34:1147-1156. [PMID: 33570723 DOI: 10.1007/s40620-020-00938-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/29/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Renal thrombotic microangiopathy (rTMA) is one of many vascular findings in Lupus Nephritis (LN). However, the influence of rTMA on prognosis has not been well established. The objective of this study was to evaluate the clinical and pathological aspects of patients with lupus and rTMA in kidney biopsy. METHODS Analysis of medical reports and kidney biopsy of 253 patients with LN, between January 2012 and December 2018. RESULTS Among our 253 patients, 43 (17%) showed acute or chronic TMA lesions on kidney histology This group had a significantly lower estimated glomerular filtration rate (eGFR) at the time of biopsy (24.1 vs. 64.15 ml/min/1.73m2, p < 0.001), at 1 year of follow up (28.1 vs. 90.7 ml/min/1.73m2, p < 0.001), and at the end of follow up (25.4 vs. 81.55 ml/min/1.73m2, p < 0.001). More patients in the rTMA group reached the composite endpoint of eGFR < 15 mL/min/1.73m2 or death or dialysis (82.9% vs. 32.9%, p < 0.001). When comparing the classical clinical TMA features, the rTMA group had higher percentages of anemia, thrombocytopenia, low haptoglobin levels, but not higher lactate dehydrogenase (LDH) levels (> 214 U/L). Combining these variables in a definition of clinical TMA, the rTMA group had a statistically higher percentage of clinical TMA (20.9% vs. 4.33%, p = 0.001). As expected, TMA group showed higher systolic blood pressure (SBP) (130 vs 129.5 mmHg, p = 0.01). Concerning histopathological features, rTMA group had significantly higher activity (9.0 vs. 6.0, p = 0.001) and chronicity (4.0 vs. 3.0, p = 0.001) scores, also a higher percentage of patients presented with crescents (76.7% vs. 57.1%, p = 0.012). CONCLUSIONS The classical clinical TMA criteria were unable to predict the presence of tissue TMA, suggesting a probably renal-limited TMA that may occur independently of systemic evident factors. Therefore, renal biopsy remains the critical method for diagnosing an important prognostic feature.
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Affiliation(s)
| | | | | | - Luis Yu
- Nephrology Division, School of Medicine, University of São Paulo, São Paulo-SP, Brazil
| | - Viktoria Woronik
- Nephrology Division, School of Medicine, University of São Paulo, São Paulo-SP, Brazil
| | - Livia Barreira Cavalcante
- Pathology Division, University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar, 255, 7º andar, Cerqueira Cesar, São Paulo-SP, Brazil
| | - Denise Maria Avancini Costa Malheiros
- Pathology Division, University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar, 255, 7º andar, Cerqueira Cesar, São Paulo-SP, Brazil
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Bagheri B, Owji SM, Torabinezhad S, Raeisi Shahraki H, Kamalinia A, Owji SH, Dehghani F. Electron microscopy study of 496 cases of lupus nephritis: A single-center experience. Lupus 2021; 30:587-596. [PMID: 33413002 DOI: 10.1177/0961203320984539] [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] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Renal involvement is seen in about 40-82% of systemic lupus erythematosus (SLE) Asian patients. The exact diagnosis and classification of lupus nephritis are important for treatment and prognosis. This study aimed to investigate the value of electron microscopy (EM) in the diagnosis and classification of lupus nephritis compared with light microscopy. METHOD In this cross-sectional referral-center 16-year study of lupus nephritis, the final diagnosis was based on the EM study. Primary light microscopy findings were compared with EM diagnosis. Moreover, Immunofluorescence patterns distribution was assessed. RESULTS From 496 patients diagnosed with lupus nephritis based on EM, 225(45.4%) of patients were categorized in class IV, followed by 98(19.7%), 93(18.8%), 46(9.3%), and 14(2.8%) who were categorized into classes of II, III, V, and VI respectively. Only 1(0.2%) patient belonged to class I, and 19(3.8%) cases were diagnosed with mixed two classes. Using EM was essential for diagnosing 25.6% of cases taking the correct classification by light microscopy into account; however, disregarding correct classification, this could change to a 7.4% contribution rate of EM. The most common cause of misdiagnosis, disregarding incorrect classification, was inadequate or wrong tissue. Positive associations were detected between tubular atrophy and interstitial fibrosis of both electron and light microscopy with different classes (P < 0.001). CONCLUSION While light microscopy is highly accurate for diagnosing lupus nephritis regardless of correct classification, EM contributes substantially to the correct classification of lupus nephritis types.
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Affiliation(s)
- Bahar Bagheri
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Mohammad Owji
- Department of Pathology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Simin Torabinezhad
- Department of Pathology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hadi Raeisi Shahraki
- Department of Biostatistics and Epidemiology, Faculty of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | | | - Seyed Hossein Owji
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farshad Dehghani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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DeQuattro K, Trupin L, Murphy LB, Rush S, Criswell LA, Lanata CM, Dall'Era M, Katz P, Yazdany J. High Disease Severity Among Asians in a US Multiethnic Cohort of Individuals with Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2020; 74:896-903. [PMID: 33337580 DOI: 10.1002/acr.24544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/15/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Knowledge about systemic lupus erythematosus (SLE) outcomes among US Asians is lacking. We examined SLE disease activity, severity, and damage among Asians of primarily Chinese and Filipino descent in a multiethnic cohort. METHODS California Lupus Epidemiology Study (CLUES, n=328) data were analyzed. Data were collected in English, Cantonese, Mandarin or Spanish, using validated instruments for disease activity (Systemic Lupus Erythematosus Disease Activity Index), disease severity (Lupus Severity Index [LSI]) and disease damage (Systemic Lupus International Collaborating Clinics Damage Index). We assessed differences in SLE outcomes among racial/ethnic groups using multivariable linear regression including interaction terms for age at diagnosis and race/ethnicity. RESULTS Asians were the largest racial/ethnic group (38%; [Chinese=22%; Filipino=9%; Other=7%]). Average age at diagnosis (years) was younger among Asians (27.9), particularly Filipinos (22.2), compared with Whites (29.4) and Blacks (34.0). After adjustment, disease activity and damage were not significantly different across groups. Disease severity among Asians was significantly higher than Whites (LSI 7.1 vs 6.5; p<0.05) but similar to Blacks and Hispanics. Early age at diagnosis was associated with greater organ damage among Asians, Blacks, and Hispanics, but not Whites. CONCLUSIONS SLE was more severe among US Asians compared to Whites. Filipinos were affected at strikingly young ages. Asians and non-White groups with younger age at diagnosis had greater organ damage than Whites. Such racial/ethnic distinctions suggest the need for heightened clinical awareness to improve health outcomes among Asians with SLE. Further study of SLE outcomes across a range of US Asian subgroups is important.
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Affiliation(s)
- Kimberly DeQuattro
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Laura Trupin
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Louise B Murphy
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia, USA
| | - Stephanie Rush
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Lindsey A Criswell
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Cristina M Lanata
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Maria Dall'Era
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Patricia Katz
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
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Pang R, Zhao J, Gan Z, Hu Z, Xue X, Wu Y, Qiao Q, Zhong A, Xia X, Liao H, Wang Z, Zhang L. Evolution of COVID-19 in patients with autoimmune rheumatic diseases. Aging (Albany NY) 2020; 12:23427-23435. [PMID: 33289698 PMCID: PMC7762508 DOI: 10.18632/aging.202193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/20/2020] [Indexed: 01/08/2023]
Abstract
The characteristics of COVID-19 patients with autoimmune rheumatic diseases (AIRD) have rarely been reported. Patients with AIRD have suppressed immune defense function, which may increase their susceptibility to COVID-19. However, the immunosuppressive agents AIRD patients routinely used may be beneficial for protecting the cytokine storm caused by SARS-CoV-2. In this retrospective study, we included all confirmed cases in Huoshenshan Hospital from February 4 to April 9. Data were extracted from electronic medical records and were analyzed for clinical and laboratory features using SPSS (version 25.0). Of 3059 patients, 21 had the comorbidities with systematic lupus erythematosus (SLE) and/or rheumatoid arthritis (RA), including 5 with SLE, 15 with RA, and 1 with Rhupus. The proportion was 57.1% for severe cases, 61.9% for either severe or critical cases, and 4.8% for critical cases. The main manifestations, ARDS and ICU admission rate, as well as the mortality and length of hospital stay of COVID-19 in AIRD patients were similar to COVID-19 patients in the general population. Our preliminary experience shows that patients with AIRD tend to have a higher risk of SARS-CoV-2 infection, and may be at risk for a severe but less likely critical disease course. Further investigation is needed to understand the immunological features of these diseases.
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Affiliation(s)
- Rongrong Pang
- COVID-19 Research Center, Institute of Laboratory Medicine, Jinling Hospital, Nanjing University School of Medicine, The First School of Clinical Medicine, Southern Medical University, Nanjing 210002, Jiangsu, China
- Department of Laboratory Medicine, Nanjing Red Cross Blood Center, Nanjing 210003, Jiangsu, China
| | - Jun Zhao
- COVID-19 Research Center, Institute of Laboratory Medicine, Jinling Hospital, Nanjing University School of Medicine, The First School of Clinical Medicine, Southern Medical University, Nanjing 210002, Jiangsu, China
- Graduate School, Nanjing Medical University, Nanjing 211166, Jiangsu, China
| | - Zhenhua Gan
- Department of Medical Administration, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
- Joint Expert Group, Wuhan Huoshenshan Hospital, Wuhan 430100, Hubei, China
| | - Zhiliang Hu
- Nanjing Infectious Disease Center, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing 210003, Jiangsu, China
- School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu, China
| | - Xiang Xue
- Department of Biochemistry and Molecular Biology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Yanjun Wu
- Department of Information, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
- Department of Information, Wuhan Huoshenshan Hospital, Wuhan 430100, Hubei, China
| | - Qinghua Qiao
- Medical and Technical Support Department, Pingdingshan Medical District, The 989th Hospital, Pingdingshan 467000, Henan, China
- Department of Laboratory Medicine and Blood Transfusion, Wuhan Huoshenshan Hospital, Wuhan 430100, Hubei, China
| | - Aifang Zhong
- Department of Laboratory Medicine and Blood Transfusion, Wuhan Huoshenshan Hospital, Wuhan 430100, Hubei, China
- Medical Technical Support Division, Changzhou Medical District, The 904th Hospital, Changzhou 213003, Jiangsu, China
| | - Xinyi Xia
- COVID-19 Research Center, Institute of Laboratory Medicine, Jinling Hospital, Nanjing University School of Medicine, The First School of Clinical Medicine, Southern Medical University, Nanjing 210002, Jiangsu, China
- Joint Expert Group, Wuhan Huoshenshan Hospital, Wuhan 430100, Hubei, China
- Department of Laboratory Medicine and Blood Transfusion, Wuhan Huoshenshan Hospital, Wuhan 430100, Hubei, China
| | - Hui Liao
- Department of Hematology, The Air Force Hospital from Eastern Theater of PLA, Nanjing 210002, Jiangsu, China
| | - Zhihua Wang
- Joint Expert Group, Wuhan Huoshenshan Hospital, Wuhan 430100, Hubei, China
- Department of Laboratory Medicine and Blood Transfusion, Wuhan Huoshenshan Hospital, Wuhan 430100, Hubei, China
- Department of Laboratory Medicine and Blood Transfusion, The 907th Hospital, Nanping 350702, Fujian, China
| | - Libo Zhang
- COVID-19 Research Center, Institute of Laboratory Medicine, Jinling Hospital, Nanjing University School of Medicine, The First School of Clinical Medicine, Southern Medical University, Nanjing 210002, Jiangsu, China
- Department of Laboratory Medicine, Nanjing Red Cross Blood Center, Nanjing 210003, Jiangsu, China
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Sae-Lim O, Laobandit I, Kitchanwit P, Laichapis M, Siripaitoon B. Prevalence and associated factors of medication nonadherence among Thai patients with systemic lupus erythematosus. Lupus 2020; 30:352-359. [PMID: 33176565 DOI: 10.1177/0961203320973072] [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: 11/15/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic disease requiring complex treatment strategies to prevent disease flare ups and to reduce hospitalizations. Medication adherence is the main concern for improving patient outcomes. Although various studies on medication nonadherence for SLE have been conducted, no definite conclusions have been reached. OBJECTIVE To quantify the prevalence of medication nonadherence among patients with SLE and to analyse the associated factors. METHODS A prospective, self-reported questionnaire study was conducted in Songklanagarind Hospital. Patient aged 18 years or older, who had an established diagnosis of SLE, and who had been receiving medications for at least 6 months, were included in the study. Medication adherence was assessed through a visual analogue scale (VAS) and through the medication-taking behaviour measure for Thai patients (MTB-Thai) scale. RESULTS One hundred and seventy-two SLE patients were enrolled in the study. Most SLE patients were young to middle aged (56.40%) and had no clinical disease activity (67.4%), as assessed by a clinical SLEDAI score. Nonadherence rates were 32% and 25.3% by VAS and the MTB-Thai scale, respectively. Patients aged 55 years or older, who used the universal coverage of health care system, who used multiple medications (>10 pills/day), and who had a good attitude towards the disease were associated with a low risk of nonadherence. CONCLUSION Up to 25% SLE patients poorly adhered to their prescriptions. Age, reimbursement scheme, pill number, and attitude towards SLE were associated with nonadherence in our patients with SLE.
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Affiliation(s)
- Orawan Sae-Lim
- Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Thailand
| | - Intouch Laobandit
- Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Thailand
| | - Punyawee Kitchanwit
- Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Thailand
| | - Manthana Laichapis
- Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Thailand
| | - Boonjing Siripaitoon
- Allergy and Rheumatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, HatYai, Thailand
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Yang F, Yang Y, Zeng W. Blockade of anti-dsDNA ameliorates systemic lupus erythematosus in MRL/Faslpr mice through ameliorating inflammation via the PKCδ-NLRC4 axis. Biochem Cell Biol 2020; 99:313-321. [PMID: 33064961 DOI: 10.1139/bcb-2020-0265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Anti-double-stranded DNA (anti-dsDNA) is closely associated with the inflammatory burden in the brain after ischemic stroke. Here, we studied the inflammatory cascade and investigated the mechanisms behind the pro-inflammatory role of dsDNA in systemic lupus erythematosus (SLE). The serum levels of interleukin-1beta (IL-1β) and IL-6 in SLE patients and the corresponding controls were evaluated using ELISA, and the expression level of caspase-1 was evaluated using quantitative real-time polymerase chain reaction (qRT-PCR). We found that the serum levels of IL-1β and IL-6 were increased in the SLE patients. The expression of caspase-1 was upregulated and positively correlated with the levels of pro-inflammatory factors. The level of anti-dsDNA was also elevated and positively correlated with the results for the mean fluorescence intensity (MFI) of caspase-1. Additionally, we evaluated the functions of PRKCD encoding protein kinase c delta (PKCδ) and NLRC4, in vivo, in MRL/Faslpr mice. We found that renal injury was aggravated, and the levels of pro-inflammatory factors were increased in the MRL/Faslpr mice. We also found that increased levels of NLRC4 in the mice exacerbated renal injury and increased the levels of pro-inflammatory factors, whereas inhibition of PKCδ had the opposite results. These findings provide unique perspectives on pathogenesis of SLE and indicate that inhibition of anti-dsDNA could attenuate renal inflammatory burden, representing a promising therapeutic opportunity for SLE.
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Affiliation(s)
- Fan Yang
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi, P.R. China.,Department of Plastic Surgery and Burns, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei, P.R. China
| | - Yinhui Yang
- Department of Plastic Surgery and Burns, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei, P.R. China
| | - Weihui Zeng
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi, P.R. China
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Gonzalez Lucero L, Barbaglia AL, Bellomio VI, Bertolaccini MC, Machado Escobar MA, Sueldo HR, Yacuzzi MS, Carrizo GA, Robles N, Rengel S, Cristofari A, Leal MO, Vasquez DL, Quinteros A, Seleme G, Molina MJ, Pera OL, Dip R, Olea AC, Torres AY, Espindola Echazu M, Arquez G, Lazaro H, Colombres F, Juarez LA, Romano O, Paz S, Santana M, Galindo L, Lucero E. Prevalence and incidence of systemic lupus erythematosus in Tucumán, Argentina. Lupus 2020; 29:1815-1820. [PMID: 32924832 DOI: 10.1177/0961203320957719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to determine the prevalence and incidence of Systemic Lupus Erythematosus (SLE) in Tucumán, Argentina. METHODS The study included inpatient and outpatient charts from four public hospitals and private practice rheumatology clinics, all of them members of the Tucumán Rheumatology Society. Patients older than 16 years with diagnosis of SLE between January 2005 and December 2012 were included. Prevalence and annual incidence were calculated as the number of cases per 100.000 inhabitants during the period 2005 to 2012. RESULTS Three hundred fifty-three patients were identified. The mean age at diagnosis was 30.5 ± 11.7 years, 93.5% women, 83% mestizos. Prevalence was 24.3 cases/100.000 inhabitants (CI 95% 22.6-28.8) and age-adjusted (≥16 years) of 34.9 cases/100.000 inhabitants (CI 95% 32.8-41.1). The annual incidence in 2005 was 1.8 cases/100.000 inhabitants (95% CI 1-2.9) and 2012 of 4.2 cases/100.000 inhabitants (95% CI 2.9-5.8). Mortality was 9.1%, with infections being the most frequent cause (14/32). CONCLUSION The prevalence of SLE in the province of Tucumán was 34.9 cases/100.000 inhabitants.
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Affiliation(s)
| | - Ana L Barbaglia
- Sociedad de Reumatología de Tucumán, San Miguel de Tucumán, Argentina
| | | | | | | | - Hector R Sueldo
- Sociedad de Reumatología de Tucumán, San Miguel de Tucumán, Argentina
| | - Maria S Yacuzzi
- Sociedad de Reumatología de Tucumán, San Miguel de Tucumán, Argentina
| | - Gustavo A Carrizo
- Sociedad de Reumatología de Tucumán, San Miguel de Tucumán, Argentina
| | - Norma Robles
- Sociedad de Reumatología de Tucumán, San Miguel de Tucumán, Argentina
| | - Silvia Rengel
- Sociedad de Reumatología de Tucumán, San Miguel de Tucumán, Argentina
| | - Alexia Cristofari
- Sociedad de Reumatología de Tucumán, San Miguel de Tucumán, Argentina
| | - Maria O Leal
- Sociedad de Reumatología de Tucumán, San Miguel de Tucumán, Argentina
| | - Doralia L Vasquez
- Sociedad de Reumatología de Tucumán, San Miguel de Tucumán, Argentina
| | - Ana Quinteros
- Sociedad de Reumatología de Tucumán, San Miguel de Tucumán, Argentina
| | - Gladys Seleme
- Sociedad de Reumatología de Tucumán, San Miguel de Tucumán, Argentina
| | - Maria J Molina
- Sociedad de Reumatología de Tucumán, San Miguel de Tucumán, Argentina
| | - Oscar L Pera
- Sociedad de Reumatología de Tucumán, San Miguel de Tucumán, Argentina
| | - Rodolfo Dip
- Sociedad de Reumatología de Tucumán, San Miguel de Tucumán, Argentina
| | - Ana C Olea
- Sociedad de Reumatología de Tucumán, San Miguel de Tucumán, Argentina
| | - Alberto Y Torres
- Sociedad de Reumatología de Tucumán, San Miguel de Tucumán, Argentina
| | | | - Gustavo Arquez
- Sociedad de Reumatología de Tucumán, San Miguel de Tucumán, Argentina
| | - Hector Lazaro
- Sociedad de Reumatología de Tucumán, San Miguel de Tucumán, Argentina
| | | | - Laura A Juarez
- Sociedad de Reumatología de Tucumán, San Miguel de Tucumán, Argentina
| | - Olga Romano
- Sociedad de Reumatología de Tucumán, San Miguel de Tucumán, Argentina
| | - Silvia Paz
- Sociedad de Reumatología de Tucumán, San Miguel de Tucumán, Argentina
| | - Mirta Santana
- Cátedra de Estadística - Facultad de Medicina - UNT, San Miguel de Tucumán, Argentina
| | - Liliana Galindo
- Cátedra de Estadística - Facultad de Medicina - UNT, San Miguel de Tucumán, Argentina
| | - Eleonora Lucero
- Sociedad de Reumatología de Tucumán, San Miguel de Tucumán, Argentina
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Assiri K, Hameed MS, Dawasaz AA, Alamoudi E, Asiri AM, Hitesh V, Ajmal M. Correlation of Buccal Micronucleus with Disease Activity Score Using Buccal Micronucleus Cytome Analysis (BMCA) in Systemic Lupus Erythematosus. Indian J Dermatol 2020; 65:265-268. [PMID: 32831365 PMCID: PMC7423229 DOI: 10.4103/ijd.ijd_620_18] [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: 11/16/2022] Open
Abstract
Background: A disease activity score obtained by using systemic lupus erythematosus disease activity index (SLEDAI) has traditionally been a reliable method to assess the SLE status of patients. More recently, a buccal micronucleus cytome assay (BMCA) has been developed for use as a biomarker of DNA damage in patients with SLE. There has been a very limited number of studies pertaining to the oral lesions in Arab population suffering from SLE in Asir region. Hence, it became utmost important to study epidemiological data of oral mucosal lesions in SLE patients. Distribution of oral lesions in SLE patients could also be helpful in better management of oral complications. Aim: The aim of this study was to determine the existence of a correlation between SLEDAI score and the degree of micronuclei (MN) formation using BMCA. Materials and Methods: After thorough oral examination of adult Saudi SLE patients of Asir hospital and that of healthy control subjects, the subjects underwent BMCA from normal unaffected bilateral buccal mucosae. Results: Pearson's correlation test showed that MN count did not significantly correlate with either disease activity or duration of SLE. Conclusions: Controlled state SLE does not lead to a significant increase in MN formation. Thus, the occurrence of premalignant lesions in the oral cavity could be minimized using proper management protocols.
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Affiliation(s)
- Khalil Assiri
- Department of Diagnostic Sciences and Oral Biology, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Mohammad Shahul Hameed
- Department of Diagnostic Sciences and Oral Biology, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Ali Azhar Dawasaz
- Department of Diagnostic Sciences and Oral Biology, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Eman Alamoudi
- Department of Diagnostic Sciences and Oral Biology, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | | | - Vij Hitesh
- Boston University Henry M. Goldman School of Dental Medicine, Boston, USA
| | - Muhammed Ajmal
- Department of Diagnostic Sciences and Oral Biology, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
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Tanaka Y, O'Neill S, Li M, Tsai IC, Yang YW. Systemic Lupus Erythematosus: Targeted literature review of the epidemiology, current treatment and disease burden in the Asia Pacific region. Arthritis Care Res (Hoboken) 2020; 74:187-198. [PMID: 32841537 DOI: 10.1002/acr.24431] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/09/2020] [Accepted: 08/18/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To understand the epidemiology, current treatment and disease burden of systemic lupus erythematosus (SLE) in the Asia Pacific region (APAC). METHODS A targeted literature review of published evidence on SLE in APAC was conducted, using the MEDLINE® database (2008-2018), conference proceedings and other supplementary sources. RESULTS The review identified 70 studies conducted in China (n=15), Japan (n=13), Taiwan (n=12), Korea (n=9), Australia (n=7), Hong Kong (n=6), Singapore (n=4), and multiple places within the APAC region (n=4). Incidence rates (per 100,000 per year) ranged from 0.9-8.4, while prevalence rates ranged from 3.7-127 (per 100,000); however, recent data was limited. Asian SLE patients were reported to have higher disease severity, activity (higher SLE disease activity index scores) and organ damage accrual; along with increased morbidity, mortality, and susceptibility to renal involvement compared with other ethnicities in APAC. The risk of developing SLE is higher in the Asian population. Routinely used SLE therapies included belimumab, hydroxychloroquine, cyclophosphamide, tacrolimus, azathioprine, mycophenolate mofetil, and corticosteroids; however, prescribing patterns varied across the region. Increased disease activity was associated with high economic burden and poor quality of life for SLE patients in APAC. CONCLUSION SLE remains a disease with a significant unmet medical need for an innovative therapy that is well-tolerated and effective for patients in APAC. Further evidence is required to better characterize the disease and fully capture the burden and impact of SLE in APAC. This review has highlighted where there is a paucity of data from patients across the APAC region.
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Affiliation(s)
- Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Sean O'Neill
- Department of Rheumatology, Royal North Shore Hospital, Northern Clinical School, University of Sydney, St Leonards, New South Wales, Australia
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, National Clinical Research Center for Immunologic Diseases, Ministry of Science & Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - I-Ching Tsai
- Janssen: Pharmaceutical Companies of Johnson & Johnson, 11F, No.2, Sec.3, Minsheng East Rd, Taipei City, Taiwan
| | - Ya-Wen Yang
- Janssen Global Services, LLC, Horsham, PA, USA
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Tangtanatakul P, Thumarat C, Satproedprai N, Kunhapan P, Chaiyasung T, Klinchanhom S, Wang YF, Wei W, Wongshinsri J, Chiewchengchol D, Rodsaward P, Ngamjanyaporn P, Suangtamai T, Mahasirimongkol S, Pisitkun P, Hirankarn N. Meta-analysis of genome-wide association study identifies FBN2 as a novel locus associated with systemic lupus erythematosus in Thai population. Arthritis Res Ther 2020; 22:185. [PMID: 32771030 PMCID: PMC7414652 DOI: 10.1186/s13075-020-02276-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/26/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Differences in the expression of variants across ethnic groups in the systemic lupus erythematosus (SLE) patients have been well documented. However, the genetic architecture in the Thai population has not been thoroughly examined. In this study, we carried out genome-wide association study (GWAS) in the Thai population. METHODS Two GWAS cohorts were independently collected and genotyped: discovery dataset (487 SLE cases and 1606 healthy controls) and replication dataset (405 SLE cases and 1590 unrelated disease controls). Data were imputed to the density of the 1000 Genomes Project Phase 3. Association studies were performed based on different genetic models, and pathway enrichment analysis was further examined. In addition, the performance of disease risk estimation for individuals in Thai GWAS was assessed based on the polygenic risk score (PRS) model trained by other Asian populations. RESULTS Previous findings on SLE susceptible alleles were well replicated in the two GWAS. The SNPs on HLA class II (rs9270970, A>G, OR = 1.82, p value = 3.61E-26), STAT4 (rs7582694, C>G, OR = 1.57, p value = 8.21E-16), GTF2I (rs73366469, A>G, OR = 1.73, p value = 2.42E-11), and FAM167A-BLK allele (rs13277113, A>G, OR = 0.68, p value = 1.58E-09) were significantly associated with SLE in Thai population. Meta-analysis of the two GWAS identified a novel locus at the FBN2 that was specifically associated with SLE in the Thai population (rs74989671, A>G, OR = 1.54, p value = 1.61E-08). Functional analysis showed that rs74989671 resided in a peak of H3K36me3 derived from CD14+ monocytes and H3K4me1 from T lymphocytes. In addition, we showed that the PRS model trained from the Chinese population could be applied in individuals of Thai ancestry, with the area under the receiver-operator curve (AUC) achieving 0.76 for this predictor. CONCLUSIONS We demonstrated the genetic architecture of SLE in the Thai population and identified a novel locus associated with SLE. Also, our study suggested a potential use of the PRS model from the Chinese population to estimate the disease risk for individuals of Thai ancestry.
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Affiliation(s)
- Pattarin Tangtanatakul
- Department of Transfusion Sciences and Clinical Microbiology, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Chisanu Thumarat
- Section of Translational Medicine, Faculty of Medicine, Mahidol University, Ramathibodi Hospital, Bangkok, Thailand
| | - Nusara Satproedprai
- Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Punna Kunhapan
- Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | | | - Siriwan Klinchanhom
- Centre of Excellent in Immunology and Immune-Mediated Diseases, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, 1873 Ratchadamri Road, Pathum wan, Bangkok, 10330, Thailand
| | - Yong-Fei Wang
- Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Sandy Bay, Hong Kong
- Shenzhen Futian Hospital for Rheumatic Disease, Shenzhen, People's Republic of China
| | - Wei Wei
- Lupus Research Institute, Affiliated Hospital of Jining Medical University, Jining, China
- Collaborative Innovation Centre for Birth Defect Research and Transformation of Shandong Province, Jining Medical University, Jining, China
| | | | - Direkrit Chiewchengchol
- Centre of Excellent in Immunology and Immune-Mediated Diseases, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, 1873 Ratchadamri Road, Pathum wan, Bangkok, 10330, Thailand
| | - Pongsawat Rodsaward
- Centre of Excellent in Immunology and Immune-Mediated Diseases, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, 1873 Ratchadamri Road, Pathum wan, Bangkok, 10330, Thailand
| | - Pintip Ngamjanyaporn
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thanitta Suangtamai
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Prapaporn Pisitkun
- Section of Translational Medicine, Faculty of Medicine, Mahidol University, Ramathibodi Hospital, Bangkok, Thailand
| | - Nattiya Hirankarn
- Centre of Excellent in Immunology and Immune-Mediated Diseases, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, 1873 Ratchadamri Road, Pathum wan, Bangkok, 10330, Thailand.
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Catalina MD, Bachali P, Yeo AE, Geraci NS, Petri MA, Grammer AC, Lipsky PE. Patient ancestry significantly contributes to molecular heterogeneity of systemic lupus erythematosus. JCI Insight 2020; 5:140380. [PMID: 32759501 PMCID: PMC7455079 DOI: 10.1172/jci.insight.140380] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023] Open
Abstract
Gene expression signatures can stratify patients with heterogeneous diseases, such as systemic lupus erythematosus (SLE), yet understanding the contributions of ancestral background to this heterogeneity is not well understood. We hypothesized that ancestry would significantly influence gene expression signatures and measured 34 gene modules in 1566 SLE patients of African ancestry (AA), European ancestry (EA), or Native American ancestry (NAA). Healthy subject ancestry-specific gene expression provided the transcriptomic background upon which the SLE patient signatures were built. Although standard therapy affected every gene signature and significantly increased myeloid cell signatures, logistic regression analysis determined that ancestral background significantly changed 23 of 34 gene signatures. Additionally, the strongest association to gene expression changes was found with autoantibodies, and this also had etiology in ancestry: the AA predisposition to have both RNP and dsDNA autoantibodies compared with EA predisposition to have only anti-dsDNA. A machine learning approach was used to determine a gene signature characteristic to distinguish AA SLE and was most influenced by genes characteristic of the perturbed B cell axis in AA SLE patients. Transcriptional profiling of lupus patients and healthy controls reveals ancestry-related differences and transcriptional heterogeneity among lupus patients.
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Affiliation(s)
- Michelle D Catalina
- AMPEL BioSolutions LLC & RILITE Research Institute, Charlottesville, Virginia, USA.,EMD Serono Research & Development Institute, Billerica, Massachusetts, USA
| | - Prathyusha Bachali
- AMPEL BioSolutions LLC & RILITE Research Institute, Charlottesville, Virginia, USA
| | | | - Nicholas S Geraci
- AMPEL BioSolutions LLC & RILITE Research Institute, Charlottesville, Virginia, USA
| | - Michelle A Petri
- Division of Rheumatology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Amrie C Grammer
- AMPEL BioSolutions LLC & RILITE Research Institute, Charlottesville, Virginia, USA
| | - Peter E Lipsky
- AMPEL BioSolutions LLC & RILITE Research Institute, Charlottesville, Virginia, USA
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Chen W, Li W, Zhang Z, Tang X, Wu S, Yao G, Li K, Wang D, Xu Y, Feng R, Duan X, Fan X, Lu L, Chen W, Li C, Sun L. Lipocalin-2 Exacerbates Lupus Nephritis by Promoting Th1 Cell Differentiation. J Am Soc Nephrol 2020; 31:2263-2277. [PMID: 32646856 DOI: 10.1681/asn.2019090937] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 05/24/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Lipocalin-2 (LCN2) is an indicator of the severity of lupus nephritis (LN) and plays a pivotal role in immune responses, but it is not known if its effect on LN pathogenesis derives from regulating the immune imbalance of T lymphocyte subsets. METHODS The expression of LCN2 in T cells and kidneys was assessed in renal biopsies from patients with LN. We investigated the relationship between LCN2 levels and development of LN and systemic illness by injecting anti-LCN2 antibodies into MRL/lpr mice and analyzing pristane-treated LCN2 -/- mice. RESULTS LCN2 is highly expressed in CD4+ T cells and in renal tissues, and is associated with severe renal damage in patients with LN and in mice with experimental lupus. LCN2 promotes IFN-γ overexpression in CD4+ T cells through the IL-12/STAT4 pathway in an autocrine or paracrine manner. Both neutralization of LCN2 in MRL/lpr mice and genetic depletion of LCN2 in pristane-induced lupus mice greatly ameliorate nephritis. The frequency and number of splenic and renal Th1 cells decrease in proportion to LN disease activity. Conversely, administration of LCN2 exacerbates the disease with significantly higher renal activity scores and increased numbers of Th1 cells. CONCLUSIONS LCN2 plays a crucial role in Th1 cell differentiation, and may present a potential therapeutic target for LN.
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Affiliation(s)
- Weiwei Chen
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Model Animal Research Center of Nanjing University, Nanjing, China
| | - Wenchao Li
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Model Animal Research Center of Nanjing University, Nanjing, China
| | - Zhuoya Zhang
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Model Animal Research Center of Nanjing University, Nanjing, China
| | - Xiaojun Tang
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Model Animal Research Center of Nanjing University, Nanjing, China
| | - Shufang Wu
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Model Animal Research Center of Nanjing University, Nanjing, China
| | - Genhong Yao
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Model Animal Research Center of Nanjing University, Nanjing, China
| | - Kang Li
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Model Animal Research Center of Nanjing University, Nanjing, China
| | - Dandan Wang
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Model Animal Research Center of Nanjing University, Nanjing, China
| | - Yuemei Xu
- Department of Pathology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Ruihai Feng
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Model Animal Research Center of Nanjing University, Nanjing, China
| | - Xiaoxiao Duan
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Model Animal Research Center of Nanjing University, Nanjing, China
| | - Xiangshan Fan
- Department of Pathology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Liwei Lu
- Department of Pathology, Center of Infection and Immunology, University of Hong Kong, Hong Kong, China
| | - WanJun Chen
- Mucosal Immunology Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland
| | - Chaojun Li
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Model Animal Research Center of Nanjing University, Nanjing, China .,State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, China
| | - Lingyun Sun
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Model Animal Research Center of Nanjing University, Nanjing, China .,State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, China
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Ho RTC, Leung MH. Factors Associated with Renal Outcomes in an Inception Cohort of Biopsy-proven Lupus Nephritis Patients. JOURNAL OF CLINICAL RHEUMATOLOGY AND IMMUNOLOGY 2020. [DOI: 10.1142/s2661341720500029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: To identify the clinical factors associated with renal response and flare in lupus nephritis (LN). Methods: All 115 patients with biopsy-proven LN diagnosed between January 2002 and June 2015 in a tertiary centre comprised of an inception cohort that was followed up until February 2017. Baseline demographic, clinical parameters, renal biopsy histology, induction and maintenance immunosuppressive therapies, complete renal response (CRR), creatinine doubling, end-stage renal disease (ESRD), renal flares and infections were retrieved and analyzed with univariate log-rank test and multivariate Cox regression. Results: At the time of the first renal biopsy, the age of patients was 38 ± 12.2 years (mean ± standard deviation), 90% female and systemic lupus erythematosus (SLE) disease duration 46 months (median); 67.0% were LN class IV or class IV + V. Patients were followed up for 104 ±49 months after biopsy. At months 3, 6, 12 and 24, a cumulative 25%, 46%, 66% and 76% of patients had achieved CRR, respectively. However, 49.5% who had CRR experienced [Formula: see text]1 infection of renal flare, with cumulative risk of 5%, 17%, 25% and 43% at year 1, 2, 3 and 5, respectively. Multivariate analysis showed that nephrotic syndrome ([Formula: see text] = 0.03) and delay of renal biopsy [Formula: see text]2 months from the onset of LN ([Formula: see text] ¡ 0.01) were negatively associated with CRR. Hydroxychloroquine use was beneficial in attaining CRR ([Formula: see text] = 0.03, hazard ratio = 1.70, 95% CI: 1.04, 2.80) and preventing renal flare ([Formula: see text] = 0.01, odds ratio = 0.51, 95% CI: 0.29, 0.88). By the end of the study, 80% of patients remained in CRR though 10.4% patients ended up in ESRD (all class IV), 8.7% died and 28.7% had [Formula: see text]1 infection episode requiring hospitalization. Conclusion: Most LN patients could achieve CRR after immunosuppressive therapy but renal flares were common over time. Infective complications were fairly frequent but the incidence of ESRD was low. The use of hydroxychloroquine was associated with better renal response and fewer flares.
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Affiliation(s)
- Roy Tsz Chung Ho
- Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong, China
| | - Moon Ho Leung
- Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong, China
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Prasad N, Kurian J, Agarwal V, Bhadauria D, Behera M, Yacha M, Kushwaha R, Agrawal V, Jain M, Gupta A. Long-term outcomes of lupus nephritis treated with regimens based on cyclophosphamide and mycophenolate mofetil. Lupus 2020; 29:845-853. [PMID: 32437258 DOI: 10.1177/0961203320926256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Lupus nephritis (LN) has a considerable impact on the morbidity and mortality of systemic lupus erythematosus (SLE) patients. Long-term comparative outcome data from the Indian subcontinent on treatment regimens with cyclophosphamide (CYP) and mycophenolate mofetil (MMF) are sparse. We assessed renal and patient survival for these patients in terms of the types of induction - CYP or MMF - and the two maintenance therapies - MMF or azathioprine (AZA). METHODS We retrospectively analysed outcomes of 100 LN patients, 67 treated with CYP (26 class III, 25 class IV, 6 class III + V and 10 class IV + V; 40 Euro lupus regimen and 27 National Institutes of Health regimen) and 33 treated with a MMF-based regimen with steroids between July 2008 and June 2018. Data regarding demographic, clinical and histopathological features and the treatment given to all patients were extracted. Outcomes between the two regimens CYP and MMF were compared in terms of remission, dialysis and patient survival. RESULTS The clinical characteristics were similar in both groups, except that the activity index was higher in CYP patients (6.13 ± 4.48 vs. 4.61 ± 2.80). However, the chronicity index was similar. The overall remission rate was 70% at the end of induction. The rates of complete remission, partial remission and non-responders in the CYP group were 46.2%, 23.9% and 29.9%, respectively. However, in the MMF group, the corresponding rates were 57.6%, 12.1% and 30.3%, respectively. The 1-, 2-, 3-, 4-, 5- and 10-year patient survival rates in the CYP group were 89.5%, 86.2%, 86.2%, 83.8%, 83.8% and 83.8%, respectively. In the MMF induction group, the corresponding rates were 93.9%, 93.9%, 89%, 89%, 89% and 89%, respectively. At the end of the study, rates of end-stage renal disease in the MMF group and CYP group were 7.5% and 12.1%, respectively. The death-censored and non-censored renal survival rates were also similar in the long term. With regard to maintenance therapy, 3/56 (5.3%) in the MMF group and 7/34 (20.5%) in the AZA group experienced doubling of serum creatinine (p = 0.03). CONCLUSIONS Long-term outcomes in terms of patient and renal survival of LN patients treated with CYP and MMF induction are similar. Doubling of serum creatinine occurred more with AZA-based maintenance therapy than with MMF-based maintenance therapy. Most deaths occurred during induction, and sepsis was the most common cause of death.
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Affiliation(s)
- Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Jithu Kurian
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Vikas Agarwal
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Dharmendra Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Manas Behera
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Monika Yacha
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ravi Kushwaha
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Vinita Agrawal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Manoj Jain
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Amit Gupta
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Predictive factors of quality of life among systemic lupus erythematosus patients in Thailand: a web-based cross-sectional study. Qual Life Res 2020; 29:2415-2423. [PMID: 32270369 DOI: 10.1007/s11136-020-02494-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study aimed to assess mental health status (depression, anxiety, and stress) and explore factors associated with the disease-specific quality of life among Systemic Lupus Erythematosus (SLE) patients in Thailand. METHODS This cross-sectional study used an online convenience sampling of 650 SLE patients who were registered members of the Thailand SLE Club. The study survey comprised of demographic information, health history, Depression, Anxiety, Stress Scale (DASS), and Lupus Quality of Life Scale (LupusQoL). RESULTS The survey response rate was 61.2%. Out of 344 respondents, most were female (96.9%). The scores were suggestive of the presence of mild depression and stress, but moderate anxiety. The higher depression, anxiety, and stress levels were associated with lower education and income (r = - .14 to - .29, p < .01) and higher number of SLE symptoms (r = .17 to .33, p < .05). Better quality of life was significantly related to lower number of symptoms, lower levels of stress/anxiety/depression, higher education, and better income. Also, the longer the patients were kept out of the hospital (last hospitalization), the better their quality of life. By using hierarchical multiple regression, four predictors of the quality of life were identified; the number of symptoms, stress, anxiety, and depression. These predictors combined explained 51% of the variance, F(5,108) = 24.34, p < .001, adjusted R2 = .51. CONCLUSIONS To improve the quality of life, SLE patients should focus on self-management of their symptoms. Health care providers should include SLE self-care health education in the plan of care. They also should use multidisciplinary approach in order to provide holistic treatment, including psychological care.
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Takeuchi T, Wakasugi N, Uno S, Makino H. Long-term Safety and Effectiveness of Tacrolimus in Patients With Lupus Nephritis: 5-year Interim Postmarketing Surveillance Study in Japan (TRUST). J Rheumatol 2020; 48:74-81. [PMID: 32238515 DOI: 10.3899/jrheum.191008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the long-term safety and effectiveness of tacrolimus for treating lupus nephritis (LN) in the real-world clinical setting. METHODS This is an ongoing, open-label, noncomparative, observational, postmarketing surveillance study conducted across 275 sites in Japan. Registered patients with LN were followed for 10 years. Here we report data relating to 5 years of tacrolimus maintenance therapy at the interim data cutoff in August 2016. RESULTS Of 1395 registered patients, 1355 received tacrolimus maintenance therapy for LN and provided safety data. The most common serious adverse drug reactions (ADR) included pneumonia (1.1%), herpes zoster (1.0%), cellulitis (1.0%), and diabetes mellitus (1.0%). ADR occurred mainly within the first 28 weeks of tacrolimus treatment, and no marked increase was observed during the follow-up period. Subgroup analyses suggested that risk factors for commonly observed ADR associated with tacrolimus included inpatient management, LN disease severity, increasing age, abnormal renal or hepatic function, and comorbid or previous disease. The cumulative rate of progression to renal failure (based on the attending physician's assessment) was 0.8% at Year 1 and 6.6% at Year 5. Cumulative relapse rates were 7.8% and 30.6%, respectively. Urine protein:creatinine ratio, serum anti-dsDNA antibody levels, complement C3 levels, and steroid-sparing effects were all significantly improved from 4 weeks after tacrolimus treatment initiation (P < 0.001) and were sustained over 5 years. CONCLUSION Long-term tacrolimus maintenance treatment over 5 years in the real-world clinical setting was well tolerated and effective in a large population of patients with LN (www.ClinicalTrials.gov: NCT01410747).
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Affiliation(s)
- Tsutomu Takeuchi
- T. Takeuchi MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo
| | - Naoko Wakasugi
- N. Wakasugi, MSc, S. Uno, MSc, Astellas Pharma Inc., Tokyo
| | - Satoshi Uno
- N. Wakasugi, MSc, S. Uno, MSc, Astellas Pharma Inc., Tokyo
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Selvananda S, Chong YY, Thundyil RJ. Disease activity and damage in hospitalized lupus patients: a Sabah perspective. Lupus 2020; 29:344-350. [PMID: 32046576 DOI: 10.1177/0961203320904155] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is a complex multi-systemic autoimmune disease with variable levels of activity that may wax and wane within the same patient over the years. In view of the scarcity of data about lupus in the East Malaysian population, we aimed to study the disease activity and damage index in patients with SLE hospitalized in a tertiary center in Sabah, East Malaysia. METHODS We retrospectively studied all patients with SLE admitted from 1 January 2013 to 31 December 2015. Demographic data, clinical features, treatment received, SLEDAI and SLICC/ACR (Systemic Lupus International Collaborating Clinics/American College of Rheumatology) criteria and outcomes were collected. RESULTS There were 108 patients studied whereby 88.9% were females. They had a mean age of 31.4 ± 11.02 years at admission and were multiethnic in origin. The mean number of ACR criteria for SLE was 5.03 ± 1.5 at the time of diagnosis. There were 158 hospitalizations during the 3 years. The main causes of hospitalization were flare of SLE (66.5%), infection (57.6%), renal biopsy (15.5%) and others (11.4%). Active nephritis (65%), cutaneous (44.4%) and hematological involvement (40.2%) were the three commonest manifestations. There was concurrent flare of SLE and infection in 41.1% of the admissions. The mean SLEDAI score at admission was 10.8 ± 7.20, with a mean SLEDAI of 9.3 ± 6.9 in those without damage and 11.9 ± 7.21 in those with damage (p-value = 0.026). The median SLICC score was 1 with a mean of 0.93 ± 1.07. There were nine deaths (5.6%) during the study period and all patients were females. Compared with those who survived, they had a significantly higher SLEDAI score of 15.80 ± 8.2 (p-value = 0.0207) and a SLICC score of 2.70 ± 1.6 (p-value <0.001). CONCLUSION SLE is more common among the indigenous population of Sabah, the Kadazan-Dusun, which has not been shown before this study. Disease characteristics were, however, similar to reports from the Asia-Pacific region. Acute flare of SLE and infection remained the main causes of admission and readmissions and was present in 44.4% of the mortalities in our cohort.
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Affiliation(s)
- S Selvananda
- Rheumatology unit, Department of Medicine, Queen Elizabeth Hospital, Sabah, Malaysia
| | | | - R J Thundyil
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Malaysia
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Cao HY, Li D, Wang YP, Lu HX, Sun J, Li HB. Clinical significance of reduced expression of lncRNA TUG1 in the peripheral blood of systemic lupus erythematosus patients. Int J Rheum Dis 2020; 23:428-434. [PMID: 31944629 DOI: 10.1111/1756-185x.13786] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/17/2019] [Accepted: 12/17/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the expression and clinical significance of long non-coding RNA taurine up-regulated gene 1 (lncRNA TUG1) in the peripheral blood of systemic lupus erythematosus (SLE) patients. METHODS With the peripheral blood mononuclear cells (PBMCs: T-cells, B-cells and monocytes) collected from SLE patients and healthy controls, TUG1 expression was determined to identify the correlation with the clinicopathological features of SLE patients. Thereby, the diagnostic value of TUG1 expression in diagnosis of SLE was evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS As compared to healthy controls, SLE patients manifested a lower expression of TUG1 in PBMCs, which was further decreased in SLE patients with lupus nephritis (P < .05). The lowest level of TUG1 was found in monocytes, rather than T-cells or B-cells (P < .05). Negative correlations were identified between TUG1 levels and SLE Disease Activity Index score (r = -.904, P < .001), erythrocyte sedimentation rate (r = -.779, P < .001), disease duration (r = -.503, P < .001) and 24-hour urinary protein (r = -.807, P < .001). Complement C3 levels were positively associated with TUG1 expression (r = .817, P < .001). In addition, the area under the ROC curve of diagnostic efficiency for SLE based on TUG1 was 0.982, and 0.930 for SLE with lupus nephritis. CONCLUSIONS The levels of lncRNA TUG1 was markedly lower in the SLE patients, which was more obvious in SLE patients with lupus nephritis, and thus, it could be a promising clinical diagnostic tool for SLE patients or SLE patients with lupus nephritis.
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Affiliation(s)
- Hai-Yu Cao
- Department of Dermatology, The First Hospital of Shijiazhuang City, Shijiazhuang, China
| | - Dong Li
- Department of Dermatology, Affiliated Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yun-Peng Wang
- Department of General Medicine, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hui-Xiu Lu
- Department of Dermatology, The First Hospital of Shijiazhuang City, Shijiazhuang, China
| | - Jing Sun
- Department of Dermatology, The First Hospital of Shijiazhuang City, Shijiazhuang, China
| | - Hai-Bin Li
- Department of General Medicine, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
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Concomitant systemic lupus erythematosus might have a negative impact on the biochemical responses to treatment in patients with primary biliary cholangitis. Clin Rheumatol 2019; 39:795-803. [DOI: 10.1007/s10067-019-04853-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/15/2019] [Accepted: 11/11/2019] [Indexed: 12/15/2022]
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Qian D, Liu L, Zhu T, Wen L, Zhu Z, Yin X, Qiu Y, Wu M, Li X, Ma J, Zhang Q, Jin L, Wang X, Xu Q, Yang S, Sheng Y, Zhang S, Zhang X. JAK2 and PTPRC mRNA expression in peripheral blood mononuclear cells from patients with systemic lupus erythematosus. Clin Rheumatol 2019; 39:443-448. [DOI: 10.1007/s10067-019-04778-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/01/2019] [Accepted: 09/11/2019] [Indexed: 01/08/2023]
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Kandane-Rathnayake R, Kent JR, Louthrenoo W, Luo SF, Wu YJJ, Lateef A, Golder V, Sockalingam S, Navarra SA, Zamora L, Hamijoyo L, Katsumata Y, Harigai M, Chan M, O’Neill S, Goldblatt F, Lau CS, Hoi A, Nikpour M, Morand E. Longitudinal associations of active renal disease with irreversible organ damage accrual in systemic lupus erythematosus. Lupus 2019; 28:1669-1677. [DOI: 10.1177/0961203319887799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective To examine longitudinal associations of active lupus nephritis with organ damage accrual in patients with systemic lupus erythematosus (SLE). Methods This study was performed using data from a large multinational prospective cohort. Active lupus nephritis at any visit was defined by the presence of urinary casts, proteinuria, haematuria or pyuria, as indicated by the cut-offs in the SLE Disease Activity Index (SLEDAI)-2K, collected at each visit. Organ damage accrual was defined as a change of SLICC-ACR Damage Index (SDI) score >0 units between baseline and final annual visits. Renal damage accrual was defined if there was new damage recorded in renal SDI domains (estimated glomerular filtration rate <50%/proteinuria >3.5 g per 24 h/end-stage kidney disease). Time-dependent hazard regression analyses were used to examine the associations between active lupus nephritis and damage accrual. Results Patients ( N = 1735) were studied during 12,717 visits for a median (inter-quartile range) follow-up period of 795 (532, 1087) days. Forty per cent of patients had evidence of active lupus nephritis at least once during the study period, and active lupus nephritis was observed in 3030 (24%) visits. Forty-eight per cent of patients had organ damage at baseline and 14% accrued organ damage. Patients with active lupus nephritis were 52% more likely to accrue any organ damage compared with those without active lupus nephritis (adjusted hazard ratio = 1.52 (95% confidence interval (CI): 1.16, 1.97), p < 0.02). Active lupus nephritis was strongly associated with damage accrual in renal but not in non-renal organ domains (hazard ratios = 13.0 (95% CI: 6.58, 25.5) p < 0.001 and 0.96 (95% CI: 0.69, 1.32) p = 0.8, respectively). There was no effect of ethnicity on renal damage accrual, but Asian ethnicity was significantly associated with reduced non-renal damage accrual. Conclusion Active lupus nephritis measured using the SLEDAI-2K domain cut-offs is associated with renal, but not non-renal, damage accrual in SLE.
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Affiliation(s)
- R Kandane-Rathnayake
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - J R Kent
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
- Department of Nephrology, Monash Health, Clayton, Australia
| | | | - S -F Luo
- Chang Gung Memorial Hospital, Taipei and Keelung, Taiwan
| | - Y -JJ Wu
- Chang Gung Memorial Hospital, Taipei and Keelung, Taiwan
| | - A Lateef
- National University Hospital, Singapore
| | - V Golder
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | | | - S a Navarra
- University of Santo Tomas Hospital, Manila, Philippines
| | - L Zamora
- University of Santo Tomas Hospital, Manila, Philippines
| | - L Hamijoyo
- University of Padjadjaran, Bandung, Indonesia
| | | | - M Harigai
- Tokyo Women’s Medical University, Japan
| | - M Chan
- Tan Tock Seng Hospital, Singapore
| | - S O’Neill
- Rheumatology Liverpool Hospital, SWS Clinical School, UNSW and the Ingham Institute for Applied Medical Research, Sydney, Australia
| | - F Goldblatt
- Royal Adelaide Hospital, Adelaide, Australia
- Flinders Medical Centre, Adelaide, Australia
| | - C S Lau
- The University of Hong Kong, Hong Kong
| | - A Hoi
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - M Nikpour
- St. Vincent’s Hospital, Melbourne, Australia
| | - E Morand
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
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Hamijoyo L, Candrianita S, Rahmadi AR, Dewi S, Darmawan G, Suryajaya BS, Rainy NR, Hidayat II, Moenardi VN, Wachjudi RG. The clinical characteristics of systemic lupus erythematosus patients in Indonesia: a cohort registry from an Indonesia-based tertiary referral hospital. Lupus 2019; 28:1604-1609. [DOI: 10.1177/0961203319878499] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Introduction To date, no national epidemiological data of systemic lupus erythematosus are available in Indonesia. Objective We aimed to demonstrate clinical characteristics of systemic lupus erythematosus patients of the Dr Hasan Sadikin General Hospital, one of Indonesia's top tertiary-referral hospitals. Method We reviewed retrospective cohort data from the Hasan Sadikin Lupus Registry, which was created in January 2016. Initial retrospective data were collected from the medical records of systemic lupus erythematosus patients from 2008 to 2015 and enhanced the cohort data from January 2016 to December 2017. The records were analysed for age, sex, clinical manifestations, comorbidity, treatment and outcome. Results Of 813 patients, 95.6% were females. Mean age at diagnosis was 27.7 ± 9.4 years, with a mean disease duration of 76.5 ± 53.1 months. Major clinical manifestations were arthritis (75.5%) and malar rash (68.3%). The majority of patients received steroid treatment, beside chloroquine and azathioprine. In total, 93 patients (11.4%) developed tuberculosis, 522 patients (64.2%) had routine follow-up and 66 patients (8.1%) died. Infection was the most common cause of death (36.4%). Conclusion Arthritis and malar rash were the most commonly encountered clinical manifestations in the Hasan Sadikin Lupus Registry. Tuberculosis incidence in systemic lupus erythematosus patients was high, as was the mortality rate of lupus.
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Affiliation(s)
- L Hamijoyo
- Department of Internal Medicine, University of Padjadjaran, Hasan Sadikin Hospital, Bandung, Indonesia
- Immunology Study Center, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - S Candrianita
- Immunology Study Center, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - A R Rahmadi
- Department of Internal Medicine, University of Padjadjaran, Hasan Sadikin Hospital, Bandung, Indonesia
| | - S Dewi
- Department of Internal Medicine, University of Padjadjaran, Hasan Sadikin Hospital, Bandung, Indonesia
- Immunology Study Center, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - G Darmawan
- Immunology Study Center, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - B S Suryajaya
- Immunology Study Center, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - NR Rainy
- Immunology Study Center, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - I I Hidayat
- Immunology Study Center, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - V N Moenardi
- Immunology Study Center, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - R G Wachjudi
- Department of Internal Medicine, University of Padjadjaran, Hasan Sadikin Hospital, Bandung, Indonesia
- Immunology Study Center, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
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Esmaeilzadeh E, Khodamoradi Z, Nazarinia MA. One-decade study of distinct features, morbidity and mortality of systemic lupus erythematosus (an update on systemic lupus erythematosus in the Fars Province of Iran). Lupus 2019; 28:1360-1367. [PMID: 31382851 DOI: 10.1177/0961203319866506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The objective of this article is to investigate the distinct features, morbidity and mortality of systemic lupus erythematosus (SLE) patients registered in rheumatology tertiary centers of Shiraz University of Medical Sciences from 2008 to 2018. METHOD A cross-sectional study was conducted on registered patients by reviewing their medical records. The clinical presentations were classified based on each organ's distinct involvement. RESULT Data of 1322 patients with a mean age of 40 at the time of the study were reviewed. The most common primary manifestation of the disease was arthralgia (37.5%), and the most common clinical presentation in course of the disease was skin involvement (61.8%). The most common cause of hospital admission was disease flare (27.8% (108/388)), and mortality was mainly due to pulmonary complications (27.5% (8/29)). Patients who had hypothyroidism had statistically significantly lower rates of constitutional symptoms (p = 0.006), gastrointestinal involvement (p = 0.024), hypertension (p = 0.002), headache (p = 0.019), depression (p = 0.049) and anemia (p = 0.014). Patients who presented with malar rash and photosensitivity in their course of disease were detected to have statistically significantly lower ages of disease onset (p = 0.013 and 0.003, respectively). CONCLUSION This study is an update to an epidemiologic study conducted in 2008 in the south of Iran. By comparing results between the two studies, we have tried to investigate the change in morbidity and mortality of SLE during these years.
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Affiliation(s)
- E Esmaeilzadeh
- Department of Internal Medicine, Division of Rheumatology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Z Khodamoradi
- Department of Internal Medicine, Division of Rheumatology, Shiraz University of Medical Sciences, Shiraz, Iran.,Shiraz Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M A Nazarinia
- Department of Internal Medicine, Division of Rheumatology, Shiraz University of Medical Sciences, Shiraz, Iran.,Shiraz Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Fernández-Ávila DG, Bernal-Macías S, Rincón-Riaño DN, Gutiérrez Dávila JM, Rosselli D. Prevalence of systemic lupus erythematosus in Colombia: data from the national health registry 2012-2016. Lupus 2019; 28:1273-1278. [PMID: 31354025 DOI: 10.1177/0961203319864168] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Registries are essential to keep track of systemic lupus erythematosus (SLE) epidemiology and to provide better care to patients. The Colombian Ministry of Health has adopted a registry (SISPRO) to gather comprehensive information coming from the Colombian health system, which provides close to universal coverage (around 95%). The information collected from SISPRO is available for scientific analysis. OBJECTIVES We used data collected by SISPRO to estimate prevalence and specific characteristics of patients with SLE registered from January 2012 to December 2016. METHODS This is a descriptive epidemiological study using the International Statistical Classification of Diseases and Related Health Problems as search terms related to SLE, based on SISPRO data. Criteria for diagnosis are not explicitly addressed in each individual case. RESULTS National records report 41,804 patients with a diagnosis of SLE for an estimated prevalence of 91.9/100,000 subjects (based on a total population of 47,663,162), being more frequent in women (89% cases). When adjusted, female and male prevalences were 204.3 and 20.2 per 100,000 (ratio 10.1) with a 7.9:1 female:male ratio, and were highest in the 45-49-year age group. CONCLUSIONS This is the first study that describes demographic characteristics of SLE in Colombia, with useful information for decision makers. It also suggests a similar prevalence to other countries.
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Affiliation(s)
- D G Fernández-Ávila
- 1 Rheumatology Unit, Department of Internal Medicine, Hospital Universitario San Ignacio, Bogotá, Colombia.,2 School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - S Bernal-Macías
- 3 Department of Internal Medicine, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - D N Rincón-Riaño
- 4 Rheumatology Unit, Hospital Militar Central - Universidad Militar Nueva Granada, Bogotá, Colombia
| | - J M Gutiérrez Dávila
- 1 Rheumatology Unit, Department of Internal Medicine, Hospital Universitario San Ignacio, Bogotá, Colombia.,2 School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - D Rosselli
- 5 Department of Clinical Epidemiology and Biostatistics, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
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Almalki AH, Alrowaie FA, Alhozali HM, Almalki NK, Alsubei AI, Alturki MS, Sadagah LF. Remission and long-term outcomes of proliferative lupus nephritis: retrospective study of 96 patients from Saudi Arabia. Lupus 2019; 28:1082-1090. [DOI: 10.1177/0961203319860584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Few data are available about the rate of short-term remission and its impact on the long-term outcomes of proliferative lupus nephritis in the Middle East. Methods An observational study was carried out involving 96 adult patients with biopsy-proven focal or diffuse proliferative lupus nephritis (PLN) from four different hospitals. Data on induction, remission and long-term outcomes were collected and analyzed. Results Among the 96 patients with biopsy-proven PLN (median age 27 (IQR: 21,34) years, 85% women and median duration of systemic lupus erythematosus (SLE) prior to diagnosis 27 (IQR: 11, 55) months), 67% developed remission at 6 months (proportion 0.67; 95% CI 0.57, 0.76). Mycophenolate mofetil (MMF) was used in 45/96 (47%), CYC in 41/95 (43%) and other agents in 10/96 (10%). The choice of MMF as induction agent has increased in recent years. Among baseline characteristics, only histologic activity was found to have a significant association with remission, with active lesions more likely to remit than active/chronic and chronic lesions (AOR 6.5, 95% CI 1.44–29.39, p = 0.015). Based on Kaplan–Meier analysis, the 5-year renal survival rate without doubling serum creatinine was 73.8%. Compared to patients with complete remission, lower long-term renal survival rates were observed in patients with no remission (89.7 versus 43%, p = 0.001) and partial remission (89.7 versus 77.6%, p = 0.256). The cumulative rate of doubling serum creatinine, dialysis, relapse and death was 23%, 11%, 10% and 5%, respectively, at 48-month median follow up. Conclusion Approximately two-thirds of patients with PLN develop remission in response to standard induction therapy. Remission was negatively associated with the presence of chronic changes in renal biopsy. Overall, MMF is the most commonly used agent to induce remission; however, with more severe disease CYC, is used more frequently. PLN is associated with significant long-term renal outcomes including a 26% cumulative rate of doubling of serum creatinine at 5 years. Initial remission predicts this long-term renal survival.
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Affiliation(s)
- A H Almalki
- Department of Medicine, Nephrology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Saudi Arabia
| | - F A Alrowaie
- Department of Medical Subspecialties, Nephrology Section, King Fahd Medical City, Riyadh, Saudi Arabia
| | - H M Alhozali
- Department of Medicine, Nephrology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia
| | - N K Almalki
- Department of Medicine, Nephrology Section, King Abdulaziz University, Jeddah, Saudi Arabia
| | - A I Alsubei
- Department of Medicine, Nephrology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia
| | - M S Alturki
- Department of Nephrology, Alhada Armed Force Hospital, Taif, Saudi Arabia
| | - L F Sadagah
- Department of Medicine, Nephrology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Saudi Arabia
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Tanaka Y, Bass D, Chu M, Egginton S, Ji B, Roth D. Organ system improvements in Japanese patients with systemic lupus erythematosus treated with belimumab: A subgroup analysis from a phase 3 randomized placebo-controlled trial. Mod Rheumatol 2019; 30:313-320. [DOI: 10.1080/14397595.2019.1630897] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, Japan
| | - Damon Bass
- Immuno-Inflammation, GSK, Philadelphia, PA, USA
| | - Myron Chu
- Immuno-Inflammation, GSK, Philadelphia, PA, USA
| | | | - Beulah Ji
- R&D Clinical Development, GSK, Uxbridge, UK
| | - David Roth
- Immuno-Inflammation, GSK, Philadelphia, PA, USA
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Infectious Aortitis with Abdominal Aortic Aneurysm in a 47-Year-Old Female with Systemic Lupus Erythematosus. Case Rep Cardiol 2019; 2019:4532169. [PMID: 31089427 PMCID: PMC6476132 DOI: 10.1155/2019/4532169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/03/2019] [Accepted: 03/17/2019] [Indexed: 11/18/2022] Open
Abstract
Aortic aneurysms are not commonly reported among patients with systemic lupus erythematosus (SLE). We report a case of a 47-year-old Filipino female diagnosed with SLE 17 years ago maintained on prolonged oral steroids, azathioprine, and hydroxychloroquine. She also had lupus nephritis, secondary hypertension, and dyslipidemia. She initially presented with a week-long watery nonbloody diarrhea with associated diffuse crampy abdominal pain and generalized weakness. She was admitted for a week at a provincial hospital and was given an unrecalled antibiotic with resolution of symptoms. Upon discharge, however, she experienced two weeks of severe right lower quadrant pain radiating to the back and left lower quadrant, with no history of diarrhea, vomiting, dysuria, and fever. Complete blood count showed slight leukocytosis and elevated C-reactive protein. Abdominal imaging revealed a saccular infrarenal aneurysm with dissection. An atherosclerotic mechanism was primarily considered, but a vasculitic process was likewise considered due to elevated acute phase reactants. The initial plan was Endovascular Aneurysm Repair (EVAR) but due to financial limitations, an exploratory laparotomy with infrarenal endoaneurysmorrhaphy was eventually performed. Intraoperative findings were a saccular infrarenal aneurysm with dissection up to the proximal right common iliac artery and an abscess compartment within the false lumen in the anterior aortic wall. Abscess culture yielded high growth of Salmonella group B. Micrographs of the aortic wall biopsy showed fibrin deposition necrosis and calcification with peripheral viable cellular infiltrates consisting of neutrophils and foamy macrophages. Inadvertently placing an endovascular graft in an infected aortic aneurysm would have led to graft infection and catastrophic morbidity. We highlight the significance of having a high index of suspicion for infectious causes of aortitis among immunocompromised patients presenting with aneurysm prior to pursuing an endovascular versus an open approach for repair.
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Chen YM, Hung WT, Liao YW, Hsu CY, Hsieh TY, Chen HH, Hsieh CW, Lin CT, Lai KL, Tang KT, Tseng CW, Huang WN, Chen YH. Combination immunosuppressant therapy and lupus nephritis outcome: a hospital-based study. Lupus 2019; 28:658-666. [PMID: 30971165 DOI: 10.1177/0961203319842663] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Lupus nephritis (LN) is the leading cause of mortality in lupus patients. This study aimed to investigate the treatment outcome and renal histological risk factors of LN in a tertiary referral center. Between 2006 and 2017, a retrospective observational study enrolled 148 biopsy-proven LN patients. After propensity score matching, 75 cases were included for further analysis. The classification and scoring of LN were assessed according to the International Society of Nephrology/Renal Pathology Society. Treatment response was evaluated by daily urine protein and urinalysis at two years after commencing induction treatment and the development of end-stage renal disease (ESRD). In total, 50.7% patients achieved complete remission (CR) or partial remission (PR), while 49.3% patients were categorized as nonresponders. Therapeutic responses in terms of CR/PR rates were associated with Systemic Lupus Erythematosus Disease Activity Index scores (odds ratio (OR): 1.34, 95% confidence interval (CI): 1.12-1.60, p = 0.001). Moreover, higher baseline creatinine levels (hazard ratio (HR): 2.10, 95% CI: 1.29-3.40, p = 0.003), higher renal activity index (HR: 1.30, 95% CI: 1.07-1.58, p = 0.008) and chronicity index (HR: 1.40, 95% CI: 1.06-1.85, p = 0.017) predicted ESRD. Among pathological scores, cellular crescents (HR: 4.42, 95% CI: 1.01-19.38, p = 0.049) and fibrous crescents (HR: 5.93, 95% CI: 1.41-24.92, p = 0.015) were independent risk factors for ESRD. In conclusion, higher lupus activity was a good prognostic marker for renal remission. Renal histology was predictive of ESRD. Large-scale prospective studies are required to verify the efficacy of mycophenolate in combination with azathioprine or cyclosporine in LN patients.
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Affiliation(s)
- Y M Chen
- 1 Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung.,2 Department of Medical Research, Taichung Veterans General Hospital, Taichung.,3 Faculty of Medicine, National Yang-Ming University, Taipei.,4 Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung
| | - W T Hung
- 1 Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung.,5 Department of Medical Education, Taichung Veterans General Hospital, Taichung.,6 Institute of Clinical Medicine, National Yang-Ming University, Taipei
| | - Y W Liao
- 1 Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung
| | - C Y Hsu
- 2 Department of Medical Research, Taichung Veterans General Hospital, Taichung
| | - T Y Hsieh
- 1 Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung.,5 Department of Medical Education, Taichung Veterans General Hospital, Taichung
| | - H H Chen
- 1 Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung.,2 Department of Medical Research, Taichung Veterans General Hospital, Taichung.,3 Faculty of Medicine, National Yang-Ming University, Taipei.,4 Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung
| | - C W Hsieh
- 1 Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung.,5 Department of Medical Education, Taichung Veterans General Hospital, Taichung
| | - C T Lin
- 1 Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung
| | - K L Lai
- 1 Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung
| | - K T Tang
- 1 Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung
| | - C W Tseng
- 1 Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung
| | - W N Huang
- 1 Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung.,3 Faculty of Medicine, National Yang-Ming University, Taipei
| | - Y H Chen
- 1 Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung.,3 Faculty of Medicine, National Yang-Ming University, Taipei
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