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Mysler E, Monticielo OA, Al-Homood IA, Lau CS, Hussein H, Chen YH. Opportunities and challenges of lupus care in Latin America, the Middle East, and Asia-Pacific: A call to action. Mod Rheumatol 2024; 34:655-669. [PMID: 38531074 DOI: 10.1093/mr/roae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/27/2023] [Indexed: 03/28/2024]
Abstract
Lupus remains a disease with a low prioritisation in the national agendas of many countries in Latin America, the Middle East, and Asia-Pacific, where there is a dearth of rheumatologists and limited access to new or even standard lupus treatments. There is thus an important need for education, advocacy, and outreach to prioritise lupus in these regions to ensure that patients receive the care they need. This article reviews some of the specific challenges facing the care and management of people with lupus in these regions and suggests strategies for improving patient outcomes. Specifically, we review and discuss (with a focus on the aforementioned regions) the epidemiology of lupus; economic costs, disease burden, and effects on quality of life; barriers to care related to disease assessment; barriers to effective treatment, including limitations of standard treatments, high glucocorticoid use, inadequate access to new treatments, and low adherence to medications; and strategies to improve lupus management and patient outcomes. We hope that this represents a call to action to come together and act now for the lupus community, policymakers, health authorities, and healthcare professionals to improve lupus management and patient outcomes in Latin America, the Middle East, and Asia-Pacific.
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Affiliation(s)
- Eduardo Mysler
- Organización Medica de Investigación, Buenos Aires, Argentina
| | - Odirlei Andre Monticielo
- Rheumatology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Chak Sing Lau
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | | | - Yi-Hsing Chen
- Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
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Schultze M, Garal-Pantaler E, Pignot M, Levy RA, Carnarius H, Schneider M, Gairy K. Clinical and economic burden of organ damage among patients with systemic lupus erythematosus in a real-world setting in Germany. BMC Rheumatol 2024; 8:18. [PMID: 38755673 PMCID: PMC11100138 DOI: 10.1186/s41927-024-00387-6] [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: 07/20/2023] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE), a chronic multisystem autoimmune disease, carries high risk of organ damage and burden to healthcare systems. SLE disease modification aims to reduce disease activity with minimal treatment toxicity and preventing or minimizing organ damage development. This real-world study utilizing healthcare administrative claims data assessed organ damage development, associated costs and healthcare resource utilization (HCRU) in patients with SLE in Germany. METHODS Claims data from January 1, 2007, to December 31, 2017, were obtained from the Betriebskrankenkassen German Sickness Fund Database. Adults (> 18 years) with a confirmed SLE diagnosis between January 1, 2009, and December 31, 2014, (inclusion period) were included. The index date was calculated based on the first recorded SLE diagnosis during this period. Patients were propensity score-matched (1:3) to a comparator cohort without SLE by age, sex, and comorbidities (Charlson comorbidity index). Organ damage was identified using an algorithm developed based on conditions described in the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), using ICD-10-GM diagnostic codes, healthcare procedures, and/or treatments. RESULTS 2121 patients with SLE and 6308 comparator patients were included (mean follow-up time: 6.4 years). Organ damage prevalence increased from 60.5% at baseline to 83.0% during 6 years of follow-up in all patients with SLE, while 17.0% of patients with SLE did not develop organ damage. Patients with newly confirmed SLE diagnosis without organ damage at baseline were nearly twice as likely to develop organ damage within 5 years versus the comparator cohort (52.0% vs. 27.0%). Total annual costs per patient-year for patients with SLE with organ damage were more than double those of patients with SLE without organ damage; both the number of inpatient admissions and length of stay were higher. CONCLUSIONS The application of a recently developed algorithm allowed us to use claims data to elucidate SLE organ damage, and its associated high clinical and economic burden, in a large, representative sample in Germany. To our knowledge, this is the first European analysis of its kind involving a broad cohort of patients with SLE treated in the routine care setting.
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Affiliation(s)
- Michael Schultze
- Berlin Center for Epidemiology and Health Research, ZEG Berlin GmbH, Invalidenstr. 115, 10115, Berlin, Germany
| | - Elena Garal-Pantaler
- Health Care Research and Health Economics (Versorgungsforschung und Gesundheitsökonomie), Team Gesundheit GmbH, Rellinghauser Straße 93, 45128, Essen, Germany
| | - Marc Pignot
- Berlin Center for Epidemiology and Health Research, ZEG Berlin GmbH, Invalidenstr. 115, 10115, Berlin, Germany
| | - Roger A Levy
- Global Medical Affairs, GSK, 1250 S Collegeville Rd, Collegeville, PA, 19426, USA
| | - Heike Carnarius
- Specialty Care Medical Affairs, GSK GmbH & Co. KG, Heidenkampsweg 51, 20097, Hamburg, Germany.
| | - Matthias Schneider
- Policlinic and Hiller Research Unit for Rheumatology, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstr 5, 40225, Düsseldorf, Germany
| | - Kerry Gairy
- GSK, Value Evidence and Outcomes, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
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Elsisi GH, Quintana G, Gil D, Santos P, Fernandez D. Clinical and economic burden of systemic lupus erythematosus in Colombia. J Med Econ 2024; 27:1-11. [PMID: 38468478 DOI: 10.1080/13696998.2024.2316536] [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: 01/12/2024] [Accepted: 02/06/2024] [Indexed: 03/13/2024]
Abstract
AIMS Our cost-of-illness (COI) model adopted payer and societal perspectives over five years to measure the economic burden of Systemic Lupus Erythematosus (SLE) in Colombia. MATERIALS AND METHODS A prevalence-based model was constructed to estimate costs and economic consequences for SLE patients in Colombia. The model included four health states: three phenotypes of SLE representing mild, moderate, and severe states and death. The clinical inputs were captured from the published literature and validated by the Delphi panel. Our model measured direct medical and indirect costs, including disease management, transient events, and indirect costs. One-way sensitivity analysis was also performed. RESULTS The number of Colombian SLE patients was 37,498. The number of SLE patients with mild, moderate, and severe phenotypes was 5343, 28757 and 3,397, respectively. SLE-patients with moderate (Colombian pesos; COP 146 billion) and severe phenotypes (COP276 billion) incurred higher costs than those with mild phenotypes (COP2 billion), over 5 years. The total SLE cost in Colombia over five years from the payer and societal perspectives was estimated to be COP 915 billion and 8 trillion, respectively. The costs per patient per year from the payer and societal perspectives were COP 4,881,902 ($3,510) and COP 46,637,054 ($33,528), respectively. CONCLUSION The burden of SLE in Colombia over five years is substantially high, mainly due to the consequences of economic loss because it affects women and men of working age, in addition to the costs of SLE management and its consequences, such as flares, infection, and organ damage. Our COI indicated that disease management costs among patients with moderate and severe SLE were substantially higher than those among patients with a mild phenotype. Therefore, more attention should be paid to limiting the progression of SLE and the occurrence of flares, with the need for further economic evaluation of novel treatment strategies that help in disease control.
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Affiliation(s)
- Gihan Hamdy Elsisi
- HTA Office, LLC, Cairo, Egypt
- Economics Department, American University in Cairo, Cairo, Egypt
| | - Gerardo Quintana
- UNAL Internal Medicine Department, Division of Rheumatology, National University of Colombia, Los Andes University, Bogotá, Colombia
| | - Diana Gil
- National University of Colombia, Artmedica SAS, Hospital Universitario Mayor MEDERI, Internal Medicina, Bogotá, Colombia
| | - Pedro Santos
- Biomab IPS, Center for Rheumatoid Arthritis, Bogota, Colombia
| | - Diana Fernandez
- Sanitas International, Data Control Committee of the GLADEL 2.0 Cohort (Latin American Lupus Study Group), Hospital Italiano de Buenos Aires, Bogotá, Colombia
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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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Chen Y, Wang L, Li N, Zhou C. Tripterygium glycosides for safely controlling disease activity in systemic lupus erythematosus: a systematic review with meta-analysis and trial sequential analysis. Front Pharmacol 2023; 14:1207385. [PMID: 37601046 PMCID: PMC10436586 DOI: 10.3389/fphar.2023.1207385] [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: 04/17/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Background: Tripterygium glycosides have been used to treat systemic lupus erythematosus (SLE) for a long time, showing the effects of immune regulation. We aimed to evaluate the benefits and risks of Tripterygium Glycosides Tablets (TGT) for patients with SLE. Methods: We searched electronic databases and clinical trial registries for relevant randomized controlled trials (RCTs). We identified eligible RCTs and assessed risk of bias. We conducted a meta-analysis to estimate the pooled effects. The Trial Sequential Analysis (TSA) 0.9.5.10 software was used to verify the reliability of the results. Results: Eight RCTs encompassing 538 patients with SLE were included. TGT combined with conventional treatments (CTs) was superior to CTs alone in reducing lupus activity (MD = -1.66, 95% CI = -2.07 to -1.26, p < 0.00001, low-certainty evidence) and improving overall response rate (ORR) (RR = 1.21, 95% CI = 1.11 to 1.32, p < 0.0001, moderate-certainty evidence). The robustness of the results was confirmed by TSA. Regarding safety, there was no statistical difference in the overall incidence of adverse reactions between the two groups. Conclusion: In patients with SLE, TGT might safely reduce disease activity. However, further high-quality studies are needed to firmly establish the clinical efficacy of TGT. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022300474; Identifier: CRD42022300474.
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Affiliation(s)
| | | | - Nannan Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Caiyun Zhou
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Chatterjee R, Pattanaik SS, Misra DP, Agarwal V, Lawrence A, Misra R, Aggarwal A. Tuberculosis remains a leading contributor to morbidity due to serious infections in Indian patients of SLE. Clin Rheumatol 2023:10.1007/s10067-023-06592-x. [PMID: 37040053 PMCID: PMC10088612 DOI: 10.1007/s10067-023-06592-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/29/2023] [Accepted: 04/02/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION Infections are a major cause of morbidity and mortality in systemic lupus erythematosus (SLE). We assessed the incidence and risk factors for major infections in SLE in India. METHODS A retrospective review of a cohort of 1354 patients of adult SLE (ACR 1997 criteria) seen between 2000 and 2021 at a single center was conducted. Serious infections (need for hospitalisation, prolonged intravenous antibiotics, disability, or death) were recorded. Cox regression was used to determine factors associated with serious infection and the effects of serious infection on survival and damage. RESULTS Among the 1354 patients (1258 females, mean age of 30.3 years, follow-up of 7127.89 person-years), there were 439 serious infections in 339 patients (61.6 per 1000 person-years follow-up). Bacterial infections (N = 226) were the most common infection followed by mycobacterial infections (n = 81), viral (n = 35), and then invasive fungal infections (N = 13). Mycobacterium tuberculosis was the single most common microbiologically confirmed organism with incidence of 1136.4/100,000 person-years with 72.8% of them being extrapulmonary. Infection free survival at 1 year and 5 years was 82.9% and 73.8%. There were 119 deaths with infection attributable mortality in 65 (54.6%). On multivariable Cox regression analysis, higher baseline activity (HR 1.02, 1.01-1.05), gastrointestinal involvement (HR 2.75, 1.65-4.69), current steroid dose (HR 1.65, 1.55-1.76), and average cumulative steroid dose per year (HR 1.007, 1.005-1.009) were associated with serious infection and higher albumin (HR 0.65, 0.56-0.76) was protective. Serious infections led to greater damage accrual (median SLICC damage index of 1 vs. 0) and mortality (HR was 18.2, 32.7 and 81.6 for the first, second, and third infections). CONCLUSION Serious infections remain a major cause of mortality and damage accrual in SLE and higher disease activity, gastrointestinal involvement, hypoalbuminemia, current steroid dose, and cumulative steroid dose are the risk factors for it.
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Affiliation(s)
- Rudrarpan Chatterjee
- Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sarit Sekhar Pattanaik
- Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Durga P Misra
- Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Vikas Agarwal
- Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Able Lawrence
- Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ramnath Misra
- Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Amita Aggarwal
- Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Wang H, Li M, Zou K, Wang Y, Jia Q, Wang L, Zhao J, Wu C, Wang Q, Tian X, Wang Y, Zeng X. Annual Direct Cost and Cost-Drivers of Systemic Lupus Erythematosus: A Multi-Center Cross-Sectional Study from CSTAR Registry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3522. [PMID: 36834216 PMCID: PMC9963905 DOI: 10.3390/ijerph20043522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND To estimate the annual direct costs and cost-drivers associated with systemic lupus erythematosus (SLE) patients in China. METHODS A multi-center, cross-sectional study was conducted based on the CSTAR registry. The information on demography and expenditures for outpatient and inpatient visits due to SLE were collected using online questionnaires. These patients' medical records were from the database of the Chinese Rheumatology Information System (CRIS). The average direct costs and 95% confidence interval were estimated using the bootstrap method with 1000 bootstrap samples by resampling with replacement. The cost-drivers were identified using multivariate regression models. RESULTS A total of 1778 SLE patients from 101 hospitals participated in our study, with 92.58% as females, a mean age of 33.8 years old, a median duration of SLE of 4.9 years, 63.8% in an active disease state, 77.3% with two organs or more damaged, and 8.3% using biologics as treatment. The average annual direct cost per patient was estimated at CNY 29,727, which approximates to 86% for direct medical costs. For moderate to severe disease activities, the use of biologics, hospitalization, treatment of moderate or high dose glucocorticoids, and peripheral vascular, cardiovascular, and/or renal system involvements were found to substantially increase the direct costs, while health insurance slightly decreased the direct costs of SLE. CONCLUSIONS This study provided reliable insight into financial pressures on individual SLE patients in China. The efforts focusing on preventing flare occurrences and limiting disease progression were recommended to further reduce the direct cost of SLE.
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Affiliation(s)
- Haiyan Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine Peking Union Medical College, Beijing 100005, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Kaiwen Zou
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine Peking Union Medical College, Beijing 100005, China
| | - Yilin Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine Peking Union Medical College, Beijing 100005, China
| | - Qiaoling Jia
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine Peking Union Medical College, Beijing 100005, China
| | - Li Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine Peking Union Medical College, Beijing 100005, China
| | - Jiuliang Zhao
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Chanyuan Wu
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Qian Wang
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Xinping Tian
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Yanhong Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine Peking Union Medical College, Beijing 100005, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
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Chen Y, Wang L, Cao Y, Li N. Total Glucosides of Paeonia lactiflora for Safely Reducing Disease Activity in Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis. Front Pharmacol 2022; 13:834947. [PMID: 35173622 PMCID: PMC8841895 DOI: 10.3389/fphar.2022.834947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/14/2022] [Indexed: 11/19/2022] Open
Abstract
Background: Total glucosides of paeony (TGP), extracted from the dried roots of Paeonia lactiflora Pall., are proven to regulate immune function in various rheumatic diseases. We aim to systematically evaluate the efficacy and safety of TGP in reducing disease activity in systemic lupus erythematosus (SLE). Methods: We searched trials in seven electronic databases and two clinical trail registries. Randomized controlled trials (RCTs) evaluating efficacy and safety of TGP for SLE were identified. The Cochrane Risk of Bias Tool 2.0 was used for quality assessment of the included trials, and RevMan 5.4 software was used for meta-analysis. Results: A total of 14 RCTs were included, including 978 participants, 492 in the intervention group and 486 in the control group. Regarding the efficacy of TGP for SLE, results showed that TGP plus conventional treatments (CTs) was superior to CTs alone in reducing disease activity (MDSLEDAI-1m = −3.54, 95% CI = −4.08 to −3.00, p < 0.00001; MDSLEDAI-2m = −3.80, 95% CI = −4.51 to −3.09, p < 0.00001; MDSLEDAI-3m = −1.62, 95% CI = −2.60 to −0.64, p < 0.0001; MDSLEDAI-6m = −1.97, 95% CI = −3.18 to −0.76, p = 0.001). The results also showed that TGP contributed to a betterment in improving other outcomes related to lupus activity, such as ESR, CRP, complement proteins (C3, C4), and immunoglobulins (IgA, IgM). In addition, TGP significantly decreased average daily glucocorticoid dosage and cumulative cyclophosamide dosage, as well as disease recurrence rate. In terms of safety, TGP may reduce the incidence of adverse reactions (RR = 0.51, 95% CI = 0.29 to 0.88, p = 0.01). The certainty of the evidence were assessed as moderate to low. Conclusion: TGP appears potentially effective and generally safe in reducing disease activity in SLE. However, in view of high risk of bias, the findings need to be confirmed in high-quality trials. Systematic Review Registration: https://www.crd.york.ac.uk/prospero, identifier CRD42021274850
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Affiliation(s)
- Yifan Chen
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Liuding Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yu Cao
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Nannan Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Hammond ER, Desta B, Near AM, Wang X, Jiang M. Frequency, severity and costs of flares increase with disease severity in newly diagnosed systemic lupus erythematosus: a real-world cohort study, United States, 2004-2015. Lupus Sci Med 2021; 8:8/1/e000504. [PMID: 34556546 PMCID: PMC8461688 DOI: 10.1136/lupus-2021-000504] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/24/2021] [Indexed: 12/31/2022]
Abstract
Objective To evaluate frequency, severity and costs of flares in US patients with newly diagnosed SLE. Methods Adults diagnosed with SLE between January 2005 and December 2014 were identified from US commercial claims data linked to electronic medical records. Disease and flare severity during 1 year after diagnosis were classified as mild, moderate or severe using a claims-based algorithm. Study outcomes included frequency and severity of flares stratified by disease severity during the 1-year post-diagnosis period and all-cause healthcare costs of flares by severity at 30, 60 and 90 days after flare. Results Among 2227 patients, 26.3%, 51.0% and 22.7% had mild, moderate and severe SLE, respectively. The overall annual flare rate was 3.5 and increased with disease severity: 2.2, 3.7 and 4.2, respectively, for mild, moderate and severe SLE (p<0.0001). Patients with severe SLE had a higher annual severe flare rate (0.6) compared with moderate (0.1) or mild SLE (0; p<0.0001). Mean total all-cause costs at 30, 60 and 90 days after flare were $16 856, $22 252 and $27 468, respectively, for severe flares (mild flares: $1672, $2639 and $3312; moderate flares: $3831, $6225, $8582; (p<0.0001, all time points)). Inpatient costs were the primary driver of the increased cost of severe flares. Conclusions Flare frequency and severity in newly diagnosed patients with SLE increase with disease severity. After a flare, healthcare costs increase over the following 90 days by disease severity. Preventing flares or reducing flare rates and duration may improve outcomes and reduce healthcare costs.
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Affiliation(s)
- Edward R Hammond
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA
| | - Barnabas Desta
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA
| | - Aimee M Near
- Real-World Evidence, IQVIA, Durham, North Carolina, USA
| | - Xia Wang
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA
| | - Miao Jiang
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA
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Jiang M, Near AM, Desta B, Wang X, Hammond ER. Disease and economic burden increase with systemic lupus erythematosus severity 1 year before and after diagnosis: a real-world cohort study, United States, 2004-2015. Lupus Sci Med 2021; 8:8/1/e000503. [PMID: 34521733 PMCID: PMC8442098 DOI: 10.1136/lupus-2021-000503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/19/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the economic burden of patients with SLE by disease severity in the USA 1 year before and after diagnosis. METHODS Patients aged ≥18 years with a first SLE diagnosis (index date) between January 2005 and December 2014 were identified from administrative commercial claims data linked to electronic medical records (EMRs). Disease severity during the year after diagnosis was classified as mild, moderate, or severe using claims-based algorithms and EMR data. Healthcare resource utilisation (HCRU) and all-cause healthcare costs (2017 US$) were reported for 1 year pre-diagnosis and post-diagnosis. Generalised linear modelling examined all-cause costs over 1 year post-index, adjusting for baseline demographics, clinical characteristics, Charlson Comorbidity Index and 1 year pre-diagnosis costs. RESULTS Among 2227 patients, 26.3% had mild, 51.0% moderate and 22.7% severe SLE. Mean per-patient costs were higher for patients with moderate and severe SLE compared with mild SLE during the year before diagnosis: mild US$12 373, moderate $22 559 and severe US$39 261 (p<0.0001); and 1-year post-diagnosis period: mild US$13 415, moderate US$29 512 and severe US$68 260 (p<0.0001). Leading mean cost drivers were outpatient visits (US$13 566) and hospitalisations (US$10 252). Post-diagnosis inpatient utilisation (≥1 stay) was higher for patients with severe (51.2%) and moderate (22.4%) SLE, compared with mild SLE (12.8%), with longer mean hospital stays: mild 0.47 days, moderate 1.31 days and severe 5.52 days (p<0.0001). CONCLUSION HCRU and costs increase with disease severity in the year before and after diagnosis; leading cost drivers post-diagnosis were outpatient visits and hospitalisations. Earlier diagnosis and treatment may improve health outcomes and reduce HCRU and costs.
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Affiliation(s)
- Miao Jiang
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA
| | - Aimee M Near
- Real-World Evidence, IQVIA, Durham, North Carolina, USA
| | - Barnabas Desta
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA
| | - Xia Wang
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA
| | - Edward R Hammond
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA
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11
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Barber MRW, Hanly JG, Su L, Urowitz MB, St Pierre Y, Romero-Diaz J, Gordon C, Bae SC, Bernatsky S, Wallace DJ, Merrill JT, Isenberg DA, Rahman A, Ginzler EM, Petri M, Bruce IN, Dooley MA, Fortin PR, Gladman DD, Sanchez-Guerrero J, Steinsson K, Ramsey-Goldman R, Khamashta MA, Aranow C, Mackay M, Alarcón GS, Manzi S, Nived O, Jönsen A, Zoma AA, van Vollenhoven RF, Ramos-Casals M, Ruiz-Irastorza G, Lim SS, Kalunian KC, Inanc M, Kamen DL, Peschken CA, Jacobsen S, Askanase A, Farewell V, Stoll T, Buyon J, Clarke AE. Economic Evaluation of Damage Accrual in an International Systemic Lupus Erythematosus Inception Cohort Using a Multistate Model Approach. Arthritis Care Res (Hoboken) 2020; 72:1800-1808. [PMID: 31609532 DOI: 10.1002/acr.24092] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 10/08/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE There is a paucity of data regarding health care costs associated with damage accrual in systemic lupus erythematosus. The present study was undertaken to describe costs associated with damage states across the disease course using multistate modeling. METHODS Patients from 33 centers in 11 countries were enrolled in the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort within 15 months of diagnosis. Annual data on demographics, disease activity, damage (SLICC/American College of Rheumatology Damage Index [SDI]), hospitalizations, medications, dialysis, and selected procedures were collected. Ten-year cumulative costs (Canadian dollars) were estimated by multiplying annual costs associated with each SDI state by the expected state duration using a multistate model. RESULTS A total of 1,687 patients participated; 88.7% were female, 49.0% were white, mean ± SD age at diagnosis was 34.6 ± 13.3 years, and mean time to follow-up was 8.9 years (range 0.6-18.5 years). Mean annual costs were higher for those with higher SDI scores as follows: $22,006 (Canadian) (95% confidence interval [95% CI] $16,662, $27,350) for SDI scores ≥5 versus $1,833 (95% CI $1,134, $2,532) for SDI scores of 0. Similarly, 10-year cumulative costs were higher for those with higher SDI scores at the beginning of the 10-year interval as follows: $189,073 (Canadian) (95% CI $142,318, $235,827) for SDI scores ≥5 versus $21,713 (95% CI $13,639, $29,788) for SDI scores of 0. CONCLUSION Patients with the highest SDI scores incur 10-year cumulative costs that are ~9-fold higher than those with the lowest SDI scores. By estimating the damage trajectory and incorporating annual costs, data on damage can be used to estimate future costs, which is critical knowledge for evaluating the cost-effectiveness of novel therapies.
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Affiliation(s)
| | - John G Hanly
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Li Su
- University of Cambridge, Cambridge, UK
| | - Murray B Urowitz
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Yvan St Pierre
- Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | | | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | | | - Daniel J Wallace
- Cedars-Sinai Medical Center and University of California, Los Angeles
| | | | | | | | - Ellen M Ginzler
- State University of New York Downstate Medical Center, Brooklyn
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ian N Bruce
- Manchester Academic Health Sciences Centre, University of Manchester and Central Manchester University Hospitals National Health Service Foundation Trust, Manchester, UK
| | | | - Paul R Fortin
- CHU de Québec, Université Laval, Quebec City, Quebec, Canada
| | - Dafna D Gladman
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | - Cynthia Aranow
- Feinstein Institutes for Medical Research, Manhasset, New York
| | - Meggan Mackay
- Feinstein Institutes for Medical Research, Manhasset, New York
| | | | - Susan Manzi
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Asad A Zoma
- Hairmyres Hospital, East Kilbride, Scotland, UK
| | | | | | | | | | | | | | | | | | - Søren Jacobsen
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anca Askanase
- Hospital for Joint Diseases, New York University Seligman Center for Advanced Therapeutics, New York, New York
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12
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Alimohammadi N, Koosha F, Rafeian-Kopaei M. Current, New and Future Therapeutic Targets in Inflammatory Bowel Disease: A Systematic Review. Curr Pharm Des 2020; 26:2668-2675. [PMID: 32250220 DOI: 10.2174/1381612826666200406081920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/10/2020] [Indexed: 12/17/2022]
Abstract
Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are chronic relapsing conditions resulting from immune system activity in a genetically predisposed individual. IBD is based on progressive damage to the inflamed gut tissue. As its pathogenesis remains unknown, recent accumulating data have demonstrated that IBD is a complex and multi-factorial disorder correlated with host luminal factors, which lead to an imbalance between pro- and anti-inflammatory signaling. The growing understanding of the molecular mechanisms responsible for IBD has suggested a wide range of potential therapeutic targets to treat this condition. Some patients do not have a satisfactory response to current therapeutic medications such as antitumor necrosis factor (TNF) agents, or their response decreases over time. As a result, IBD therapeutics have been changed recently, with several new agents being evaluated. The identification of various inflammatory cascades has led to forming the idea to have novel medications developed. Medications targeting Janus kinases (JAK), leukocyte trafficking Interleukin (IL) 12/23, and Sphingosine 1 phosphate (S1P) are among these newly developed medications and highlight the role of microbial-host interaction in inflammation as a safe promising strategy. This systematic review aims to summarize different molecular targeting therapeutics, the most potent candidates for IBD treatment in recent studies.
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Affiliation(s)
- Niloufar Alimohammadi
- Department of Medicine, New York University School of Medicine, New York, New York, United States
| | - Farzad Koosha
- Department of Oral Biology and Pathology, School of Dental Medicine, State University of New York at Stony Brook, New York, United States
| | - Mahmoud Rafeian-Kopaei
- Medical Plants Research Center, Basic Health Sciences Institute, Shahre-kord University of Medical Sciences, Shahre-kord, Iran
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13
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Urowitz MB, Gladman DD, Ibañez D, Su J, Mursleen S, Sayani A, Ross Terres JA, Iczkovitz S. Effect of Disease Activity on Organ Damage Progression in Systemic Lupus Erythematosus: University of Toronto Lupus Clinic Cohort. J Rheumatol 2020; 48:67-73. [DOI: 10.3899/jrheum.190259] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 11/22/2022]
Abstract
Objective.To examine the role of disease activity on organ damage over 5 years in patients with active systemic lupus erythematosus (SLE) despite standard of care.Methods.This analysis of the University of Toronto Lupus Clinic cohort assessed organ damage [measured by Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)] in patients with active SLE [SLE Disease Activity Index 2000 (SLEDAI-2K) ≥ 6], using Cox proportional time-independent hazard models. Subgroup analyses were conducted in patients with SLEDAI-2K 6 or 7, 8 or 9, and ≥ 10 at baseline, and in the overall study population by steroid dose at study entry (< 7.5 vs ≥ 7.5 mg/day).Results.Among the overall study population (n = 649), SDI progression was observed in 209 (32.2%) patients over the 5-year follow-up period. Mean SDI change in patients with a score > 0 was generally consistent across all SLEDAI-2K subgroups. Multivariable analyses identified age at study start (HR 1.03, P < 0.0001), steroid dose (HR 2.03, P < 0.0001), immunosuppressants (HR 1.44, P = 0.021), and SLEDAI-2K (subgroup analyses HR 1.64–2.03, P = 0.0017 to < 0.0001) as the greatest risk factors for SDI progression, while a study start date after the year 2000 had a protective effect on SDI progression compared with a start date prior to the year 2000 (HR 0.65, P = 0.0004).Conclusion.Patients within the higher SLEDAI-2K subgroups at study entry or receiving high doses of steroids were more likely to have organ damage progression.
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14
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Legge A, Kirkland S, Rockwood K, Andreou P, Bae SC, Gordon C, Romero-Diaz J, Sanchez-Guerrero J, Wallace DJ, Bernatsky S, Clarke AE, Merrill JT, Ginzler EM, Fortin PR, Gladman DD, Urowitz MB, Bruce IN, Isenberg DA, Rahman A, Alarcón GS, Petri M, Khamashta MA, Dooley MA, Ramsey-Goldman R, Manzi S, Zoma AA, Aranow C, Mackay M, Ruiz-Irastorza G, Lim SS, Inanc M, van Vollenhoven RF, Jonsen A, Nived O, Ramos-Casals M, Kamen DL, Kalunian KC, Jacobsen S, Peschken CA, Askanase A, Hanly JG. Prediction of Damage Accrual in Systemic Lupus Erythematosus Using the Systemic Lupus International Collaborating Clinics Frailty Index. Arthritis Rheumatol 2020; 72:658-666. [PMID: 31631584 DOI: 10.1002/art.41144] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/15/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The Systemic Lupus International Collaborating Clinics (SLICC) frailty index (FI) has been shown to predict mortality, but its association with other important outcomes is unknown. We examined the association of baseline SLICC FI values with damage accrual in the SLICC inception cohort. METHODS The baseline visit was defined as the first visit at which both organ damage (SLICC/American College of Rheumatology Damage Index [SDI]) and health-related quality of life (Short Form 36) were assessed. Baseline SLICC FI scores were calculated. Damage accrual was measured by the increase in SDI between the baseline assessment and the last study visit. Multivariable negative binomial regression was used to estimate the association between baseline SLICC FI values and the rate of increase in the SDI during follow-up, adjusting for relevant demographic and clinical characteristics. RESULTS The 1,549 systemic lupus erythematosus (SLE) patients eligible for this analysis were mostly female (88.7%) with a mean ± SD age of 35.7 ± 13.3 years and a median disease duration of 1.2 years (interquartile range 0.9-1.5 years) at baseline. The mean ± SD baseline SLICC FI was 0.17 ± 0.08. Over a mean ± SD follow-up of 7.2 ± 3.7 years, 653 patients (42.2%) had an increase in SDI. Higher baseline SLICC FI values (per 0.05 increase) were associated with higher rates of increase in the SDI during follow-up (incidence rate ratio [IRR] 1.19 [95% confidence interval 1.13-1.25]), after adjusting for age, sex, ethnicity/region, education, baseline SLE Disease Activity Index 2000, baseline SDI, and baseline use of glucocorticoids, antimalarials, and immunosuppressive agents. CONCLUSION Our findings indicate that the SLICC FI predicts damage accrual in incident SLE, which further supports the SLICC FI as a valid health measure in SLE.
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Affiliation(s)
| | | | | | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Caroline Gordon
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Juanita Romero-Diaz
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Jorge Sanchez-Guerrero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Daniel J Wallace
- Cedars-Sinai Medical Center and David Geffen School of Medicine at University of California, Los Angeles
| | | | - Ann E Clarke
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | | | - Paul R Fortin
- CHU de Quebec-Université Laval, Quebec City, Quebec, Canada
| | - Dafna D Gladman
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Murray B Urowitz
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Ian N Bruce
- Arthritis Research UK Epidemiology Unit, University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Centre, and Manchester University NHS Foundation Trust, Manchester, UK
| | | | | | | | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Munther A Khamashta
- St. Thomas Hospital and King's College London GKT School of Medical Education, London, UK
| | - M A Dooley
- University of North Carolina at Chapel Hill
| | | | - Susan Manzi
- Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania
| | | | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, New York
| | - Meggan Mackay
- Feinstein Institute for Medical Research, Manhasset, New York
| | | | - S Sam Lim
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | - Manuel Ramos-Casals
- Institut d'Investigacions Biomèdiques August Pi i Sunyer and Hospital Clínic, Barcelona, Barcelona, Spain
| | | | | | - Soren Jacobsen
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Anca Askanase
- Hospital for Joint Diseases, New York University New York, New York
| | - John G Hanly
- Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
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15
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Prada SI, Perez AM, Nieto-Aristizábal I, Tobón GJ. Direct cost of lupus care in the developing world: the case of Colombia. Lupus 2019; 28:970-976. [DOI: 10.1177/0961203319856093] [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 Lupus is a chronic autoimmune and incurable rheumatic disease and has a global prevalence of 3.2–517.5 cases per 100,000 people. However, currently there is no knowledge regarding the actual direct cost of patients with lupus to healthcare systems in developing countries. This study aimed to determine the direct cost of lupus care in Colombia. Methods To identify patients with lupus, claims data of 2 years from two health insurers were subjected to an algorithm according to International Statistical Classification of Diseases and Related Health Problems 10th Revision codes. Multivariate linear regression analyses were used to assess the direct cost of lupus care. Results The average annual per-patient, all-claims, all-cause direct cost was $2355; this is approximately 9 times the average annual premium received by health insurers for covering the public benefits package. Approximately 50% of direct costs are not included in the public benefits package. The incidence of one or more condition is 98.4%. The direct cost incurred by patients with two comorbidities was 1.8 times more, with three chronic conditions was 1.9 times more and with six chronic conditions was 4.5 times more than that incurred by patients with only lupus. Conclusions The direct cost of lupus care in the developing world may be higher than expected; in addition, access to healthcare may not be equal for the entire population.
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Affiliation(s)
- SI Prada
- Centro PROESA, Universidad Icesi, Cali, Colombia
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - AM Perez
- Centro PROESA, Universidad Icesi, Cali, Colombia
| | - I Nieto-Aristizábal
- Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional (GIRAT), Universidad Icesi and Fundación Valle del Lili, Cali, Colombia
| | - GJ Tobón
- Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional (GIRAT), Universidad Icesi and Fundación Valle del Lili, Cali, Colombia
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16
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Zhang L, Luan W, Geng S, Ye S, Wang X, Qian L, Ding Y, Li T, Jiang A. Lack of patient education is risk factor of disease flare in patients with systemic lupus erythematosus in China. BMC Health Serv Res 2019; 19:378. [PMID: 31196083 PMCID: PMC6567412 DOI: 10.1186/s12913-019-4206-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 05/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To explore the inadequacies of health service and its impact on clinical outcomes of patients with systemic lupus erythematosus (SLE) in China. METHODS A total of 210 SLE patients were randomly recruited between January 2017 and January 2018. Each patient received self-report questionnaires to assess medication adherence [Compliance Questionnaire for Rheumatology (CQR)], beliefs about medicines [Beliefs about Medicines Questionnaire (BMQ)] and satisfaction about medicine information [the Satisfaction with Information about Medicines Scale (SIMS)]. Associations between SLE disease activity index (SLEDAI-2 K) and observed factors were analyzed by multiple logistic regression. RESULTS Based on CQR, only 28.10% patients were adherent. The score of BMQ was 2.85 ± 5.42, and merely 32.38% patients were satisfied with the information about their prescribed medicines. Disease activity was associated with SIMS, EuroQol five-dimensions [EQ5D], Systemic Lupus International Collaborating Clinics (SLICC), depression, use of NSAID (P ≤ 0.05). Remission of disease was positively correlated with SIMS (OR = 0.16, 95% CI: [0.06, 0.40]), and BMQ (OR = 0.64, 95%CI: [0.43, 0.94]). CONCLUSION In this study, the scores of BMQ and SIMS were low, implying defects in the patient education of health service system, which led to disease flare in Chinese SLE patients. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT03024307 . Registered January 18, 2017.
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Affiliation(s)
- Le Zhang
- Department of Pharmacy, South Campus, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Luan
- School of Nursing, Shanghai Second Military Medical University, Shanghai, China.,Department of Nursing, South Campus, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.2000 Jiangyue RD, Shanghai, 201112, China
| | - Shikai Geng
- Department of Rheumatology, South Campus, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shuang Ye
- Department of Rheumatology, South Campus, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaodong Wang
- Department of Rheumatology, South Campus, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Liping Qian
- Department of Nursing, South Campus, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.2000 Jiangyue RD, Shanghai, 201112, China
| | - Yang Ding
- Department of Mathematics, Applied Statistics, Shanghai Jiao tong University, Shanghai, China
| | - Ting Li
- Department of Rheumatology, South Campus, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Anli Jiang
- School of Nursing, Shanghai Second Military Medical University, Shanghai, China.
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17
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Kiadaliri AA, Mohammad AJ, Englund M. Hospitalizations due to systemic connective tissue diseases: Secular trends and regional disparities in Sweden, 1998-2016. Int J Rheum Dis 2018; 21:1900-1906. [PMID: 30168267 DOI: 10.1111/1756-185x.13341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM To investigate secular trends and regional disparities in hospitalizations due to systemic connective tissue diseases (SCTD) in Sweden from 1998 to 2016. METHOD We identified all hospital admissions with a principal diagnosis of SCTD (ICD-10 codes: M30-M36) from the Swedish National Patient Register. Joinpoint regression was used to assess secular trends in age-standardized hospitalization rates (ASHR) and proportions of SCTD from all and musculoskeletal disorders hospitalizations. We also assessed the secular trends in the absolute and relative regional disparities of SCTD hospitalizations. RESULTS We identified 89 333 SCTD hospitalizations (0.3% of all hospitalizations), of these about 69% were for women and 49% of patients were aged 15-64 years. Polyarteritis nodosa and related conditions (PANRC) and systemic lupus erythematosus (SLE) were the most frequent SCTD among those aged <10 years and 10-54 years, respectively. Joinpoint regression suggested that both rates and proportions of SCTD hospitalizations declined over time. These trends persisted among sex, age and diagnosis subgroups except for PANRC in patients aged 0-19 years who observed an average annual increase of 3.4% (95% CI: 1.8, 5.1) over the study period. There were 2.4-fold (95% CI: 2.3-2.5) difference between the regions with the highest and lowest mean ASHR. There was no statistically significant secular trend in the relative regional disparities, whereas the absolute regional disparity declined over time. CONCLUSION There were substantial decreases in the absolute and relative burden of SCTD hospitalizations reflecting possible improvements in disease management in Sweden. The rising trend in PANRC among the youngest children warrants further investigation.
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Affiliation(s)
- Aliasghar A Kiadaliri
- Clinical Epidemiology Unit, Department of Clinical Sciences-Lund, Orthopaedics, Faculty of Medicine, Lund University, Lund, Sweden
| | - Aladdin J Mohammad
- Clinical Epidemiology Unit, Department of Clinical Sciences-Lund, Orthopaedics, Faculty of Medicine, Lund University, Lund, Sweden.,Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK
| | - Martin Englund
- Clinical Epidemiology Unit, Department of Clinical Sciences-Lund, Orthopaedics, Faculty of Medicine, Lund University, Lund, Sweden.,Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts
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18
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Sjöwall C, Mandl T, Skattum L, Olsson M, Mohammad AJ. Epidemiology of hypocomplementaemic urticarial vasculitis (anti-C1q vasculitis). Rheumatology (Oxford) 2018; 57:1400-1407. [PMID: 29718374 DOI: 10.1093/rheumatology/key110] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Indexed: 11/12/2022] Open
Abstract
Objectives The aim was to describe the clinical characteristics and epidemiology of hypocomplementaemic urticarial vasculitis (HUV; anti-C1q vasculitis) in two geographically defined areas of Sweden. Methods In the health-care districts surrounding Skåne University Hospital (mean population 950 560) and Linköping University Hospital (mean population 428 503), all incident cases of HUV residing within the study areas at the onset of disease were identified during the years 2000-15. The diagnosis of HUV was confirmed by review of medical records. Only patients meeting the proposed diagnostic HUV criteria and/or the 2012 Chapel Hill consensus definitions in combination with an ever-positive anti-C1q antibody test were included. Results Sixteen patients (14 females) were identified during the study period. The median (interquartile range) age at diagnosis was 51 (40.7-56.7) years. Median (interquartile range) time of follow-up from diagnosis to 31 December 2015, or death, was 94 (46.5-136.2) months. The most frequent manifestations at diagnosis were urticaria (100%), arthritis (88%), followed by biopsy-proven glomerulonephritis (19%), episcleritis/scleritis (19%) and recurrent abdominal pain (13%). The annual incidence rate per million inhabitants was estimated as 0.7 (95% CI: 0.4, 1.1). Sixty-three per cent suffered from pulmonary disease at the last follow-up. Two patients died during the follow-up period. One patient underwent lung transplantation, and two patients proceeded to end-stage renal disease. The point prevalence on 31 December 2015 was 9.5/million (95% CI: 4.5, 14.5). Conclusion Hypocomplementaemic urticarial vasculitis constitutes a rare, but not always benign condition. Renal and lung manifestations were severe in some cases, highlighting the need for careful screening and monitoring of this potentially serious condition.
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Affiliation(s)
- Christopher Sjöwall
- Division of Neuro & Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Thomas Mandl
- Department of Clinical Sciences Malmö, Rheumatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Lillemor Skattum
- Clinical Immunology and Transfusion Medicine, Office for Medical Services, Lund, Sweden.,Department of Laboratory Medicine, Section of Microbiology, Immunology and Glycobiology, Lund University, Lund, Sweden
| | - Martin Olsson
- Clinical Immunology and Transfusion Medicine, Office for Medical Services, Lund, Sweden
| | - Aladdin J Mohammad
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Medicine, University of Cambridge, Cambridge, UK
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19
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Choi MY, Barber MRW, Barber CEH, Clarke AE, Fritzler MJ. Preventing the development of SLE: identifying risk factors and proposing pathways for clinical care. Lupus 2017; 25:838-49. [PMID: 27252260 DOI: 10.1177/0961203316640367] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Although challenging, developing evidence-based approaches to an early and accurate diagnosis of systemic lupus erythematosus is a key approach to preventing disease and lupus-associated morbidity and mortality. Advances in our understanding of preclinical and incomplete lupus erythematosus have enabled the identification of risk factors that may predict disease and the development of potential strategies aimed at primary prevention. Emerging data support the notion that there is a temporal disease progression from initial asymptomatic autoimmunity (preclinical lupus) through early clinical features of the disease (incomplete lupus erythematosus) to finally becoming fully classifiable systemic lupus erythematosus (complete lupus erythematosus). Here, we review the demographic, clinical, biomarker as well as genetic and environmental features that are reported to increase the risk of disease progression. Based on these risk factors, we propose a clinical care pathway for patients with early disease. We envisage that such a pathway, through early identification of disease, may improve patient outcomes, while reducing health care costs.
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Affiliation(s)
- M Y Choi
- University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - M R W Barber
- University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - C E H Barber
- University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - A E Clarke
- University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - M J Fritzler
- University of Calgary, Cumming School of Medicine, Calgary, Canada
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Zhang L, Lu GH, Ye S, Wu B, Shen Y, Li T. Treatment adherence and disease burden of individuals with rheumatic diseases admitted as outpatients to a large rheumatology center in Shanghai, China. Patient Prefer Adherence 2017; 11:1591-1601. [PMID: 29075106 PMCID: PMC5609799 DOI: 10.2147/ppa.s144624] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE The purpose of this study was to determine treatment adherence and disease burden, analyze detailed medication problems experienced by patients, and identify factors associated with adherence in patients with rheumatic diseases in China. PATIENTS AND METHODS Patients with confirmed diagnoses of ankylosing spondylitis (AS), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE) were recruited, regardless of demographics, disease severity, and treatment characteristics. Adherence was assessed using the Compliance Questionnaire for Rheumatology and interview-based self-reports. A backwards-stepwise multivariate regression analysis was used to identify factors associated with adherence. RESULTS We collected data on 252 patients who had a rheumatic disease and visited our outpatient clinic in January or February of 2017. There were 121 patients with SLE, 70 with RA, and 61 with AS. The overall adherence rate was 41.7%, with 48.7% for SLE patients, 38.6% for RA patients, and 31.1% for AS patients. The overall EuroQol (EQ)-index was 0.761; AS patients had the best EQ-index (0.792), followed by those with SLE (0.780) and RA (0.700). SLE patients also had greater annual direct costs (US$5,103.58) than RA or AS patients. CONCLUSION Overall, 41.7% of our rheumatic disease patients were adherent to treatment, lower than in many other parts of the world. This indicates that it is important to identify methods that improve adherence in this population. It is particularly important to improve the health status and reduce the disease burden of patients with SLE, the most common of the three rheumatic diseases we analyzed. Our results suggest that reminder tools may improve adherence. Further prospective research is needed to confirm whether reminder tools and other measures can improve patient compliance.
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Affiliation(s)
- Le Zhang
- Department of Pharmacy, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Guo Hong Lu
- Department of Pharmacy, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shuang Ye
- Department of Rheumatology, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Bin Wu
- Department of Pharmacy, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yi Shen
- Department of Mathematics, Applied Statistics, Shanghai Jiaotong University, Shanghai, China
| | - Ting Li
- Department of Rheumatology, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Correspondence: Ting Li, Department of Rheumatology, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 2000 Jiangyue Road, Shanghai 201112, China, Tel +86 139 1692 7066, Fax +86 21 3450 6151, Email
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Carter EE, Barr SG, Clarke AE. The global burden of SLE: prevalence, health disparities and socioeconomic impact. Nat Rev Rheumatol 2016; 12:605-20. [PMID: 27558659 DOI: 10.1038/nrrheum.2016.137] [Citation(s) in RCA: 273] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that can potentially lead to serious organ complications and even death. Its global burden - in terms of incidence and prevalence, differential impact on populations, economic costs and capacity to compromise health-related quality of life - remains incompletely understood. The reported worldwide incidence and prevalence of SLE vary considerably; this variation is probably attributable to a variety of factors, including ethnic and geographic differences in the populations being studied, the definition of SLE applied, and the methods of case identification. Despite the heterogeneous nature of the disease, distinct patterns of disease presentation, severity and course can often be related to differences in ethnicity, income level, education, health insurance status, level of social support and medication compliance, as well as environmental and occupational factors. Given the potential for the disease to cause such severe and widespread organ damage, not only are the attendant direct costs high, but these costs are sometimes exceeded by indirect costs owing to loss of economic productivity. As an intangible cost, patients with SLE are, not surprisingly, likely to endure considerably reduced health-related quality of life.
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Affiliation(s)
- Erin E Carter
- University of Calgary, Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road S.W., Calgary, Alberta T2T 5C7, Canada
| | - Susan G Barr
- University of Calgary, Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road S.W., Calgary, Alberta T2T 5C7, Canada
| | - Ann E Clarke
- University of Calgary, Health Research Innovation Centre, 3280 Hospital Drive N.W., Calgary, Alberta T2N 4N1, Canada
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Jönsen A, Hjalte F, Willim M, Carlsson KS, Sjöwall C, Svenungsson E, Leonard D, Bengtsson C, Rantapää- Dahlqvist S, Pettersson S, Gunnarsson I, Zickert A, Gustafsson JT, Rönnblom L, Petersson IF, Bengtsson AA, Nived O. Direct and indirect costs for systemic lupus erythematosus in Sweden. A nationwide health economic study based on five defined cohorts. Semin Arthritis Rheum 2016; 45:684-90. [DOI: 10.1016/j.semarthrit.2015.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 11/12/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
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Björk M, Dahlström Ö, Wetterö J, Sjöwall C. Quality of life and acquired organ damage are intimately related to activity limitations in patients with systemic lupus erythematosus. BMC Musculoskelet Disord 2015; 16:188. [PMID: 26264937 PMCID: PMC4531389 DOI: 10.1186/s12891-015-0621-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 07/03/2015] [Indexed: 11/24/2022] Open
Abstract
Background Systemic lupus erythematosus (SLE) is an autoimmune multi-organ disease, characterized by episodes of disease flares and remissions over time, which may restrain affected patients’ ability to perform daily activities. The purpose of the present study was to characterize variation in activity limitations among well-defined SLE patients, and to describe disease phenotypes, acquired organ damage and their relations to activity limitation and self-reported health, respectively. Methods The disease phenotypes were organized into 4 different clinical groups and logistic regression analyses were used to identify how an elevated health assessment questionnaire (HAQ) score was related to disease variables such as phenotypes, disease activity and damage accrual. Correlation and multiple linear regression analyses were used to examine the association between each group of variables – background variables, disease variables and self-reported measurements – and the degree of elevated HAQ. Results We found a higher proportion of activity limitation in patients with skin and joint involvement compared to others. The presence of activity limitation, as detected by the HAQ instrument, was significantly associated with quality of life (EuroQol–5D) and accrual of organ damage using the Systemic Lupus International Collaborative Clinics/ACR damage index. Conclusions The findings highlight the differing requirements of the multi-professional rehabilitation interventions for the various SLE phenotypes in order to optimize the clinical care of the patients.
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Affiliation(s)
- Mathilda Björk
- Rehabilitation Center and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. .,Department of Rehabilitation, School of Health Sciences, Jönköping University, Jönköping, Sweden.
| | - Örjan Dahlström
- Swedish Institute for Disability Research, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
| | - Jonas Wetterö
- Rheumatology/AIR, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Christopher Sjöwall
- Rheumatology/AIR, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
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