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Kandane-Rathnayake R, Louthrenoo W, Golder V, Luo SF, Wu YJJ, Lateef A, Cho J, Li Z, An Y, Hamijoyo L, Navarra S, Zamora L, Katsumata Y, Harigai M, Sockalingam S, Chan M, Chen YH, O'Neill S, Goldblatt F, Hao Y, Zhang Z, Kikuchi J, Takeuchi T, Lau CS, Nikpour M, Morand E, Hoi A. Independent associations of lymphopenia and neutropenia in patients with systemic lupus erythematosus: a longitudinal, multinational study. Rheumatology (Oxford) 2021; 60:5185-5193. [PMID: 33693676 PMCID: PMC8566254 DOI: 10.1093/rheumatology/keab217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/23/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The prevalence and associations of leucopenia in SLE remain incompletely understood. We evaluated associations of disease activity and medication use with leucopenia (lymphopenia and neutropenia) in a multinational, prospectively followed SLE cohort. METHODS Data from the Asia Pacific Lupus Collaboration cohort, in which disease activity and medications were prospectively captured from 2013 to 2018, were used. Predictors of lymphopenia (lymphocyte count <0.8 × 109/l) and neutropenia (neutrophil count <1.5 × 109/l) were examined using multiple failure, time-dependent survival analyses. RESULTS Data from 2330 patients and 18 287 visits were analysed. One thousand and eighteen patients (43.7%) had at least one episode of leucopenia; 867 patients (37.2%) had lymphopenia, observed in 3065 (16.8%) visits, and 292 (12.5%) patients had neutropenia, in 622 (3.4%) visits. After multivariable analyses, lymphopenia was associated with overall disease activity, ESR, serology, prednisolone, AZA, MTX, tacrolimus, CYC and rituximab use. MTX and ciclosporin were negatively associated with neutropenia. Lupus low disease activity state was negatively associated with both lymphopenia and neutropenia. CONCLUSION Both lymphopenia and neutropenia were common in SLE patients but were differentially associated with disease and treatment variables. Lymphopenia and neutropenia should be considered independently in studies in SLE.
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Affiliation(s)
- Rangi Kandane-Rathnayake
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Worawit Louthrenoo
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University Hospital, Thailand
| | - Vera Golder
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Shue-Fen Luo
- Chang Gung Memorial Hospital, Rheumatology, Allergy and Immunology, Taipei and Keelung, Taiwan
| | - Yeong-Jian J Wu
- Chang Gung Memorial Hospital, Rheumatology, Allergy and Immunology, Taipei and Keelung, Taiwan
| | - Aisha Lateef
- National University Hospital, University Medicine Cluster, Singapore, Singapore
| | - Jiacai Cho
- National University Hospital, University Medicine Cluster, Singapore, Singapore
| | - Zhanguo Li
- Department of Rheumatology and Immunology, People's Hospital, Peking University Health Science Center, Beijing, China
| | - Yuan An
- Department of Rheumatology and Immunology, People's Hospital, Peking University Health Science Center, Beijing, China
| | - Laniyati Hamijoyo
- Division of Rheumatology, Padjadjaran University/Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Sandra Navarra
- Section of Rheumatology, University of Santo Tomas Hospital, Manila, Philippines
| | - Leonid Zamora
- Section of Rheumatology, University of Santo Tomas Hospital, Manila, Philippines
| | - Yasuhiro Katsumata
- Department of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayoshi Harigai
- Department of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Madelynn Chan
- Rheumatology, Allergy & Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Sean O'Neill
- Liverpool Hospital and the Ingham Institute for Applied Medical Research, Rheumatology, Liverpool, NSW
| | - Fiona Goldblatt
- Department of Rheumatology, Royal Adelaide Hospital
- Flinders Medical Centre, Department of Rheumatology, Adelaide, South Australia, Australia
| | - Yanjie Hao
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Jun Kikuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan
| | - Chak Sing Lau
- The University of Hong Kong, Medicine, Hong Kong, Hong Kong
| | - Mandana Nikpour
- The University of Melbourne at St. Vincent's Hospital, Medicine and Rheumatology, Melbourne, Victoria, Australia
| | - Eric Morand
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Alberta Hoi
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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