SAT0216 DISEASE SEVERITY, COMORBID CONDITIONS, TREATMENT PATTERNS, AND FLARES IN ADULTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS IN THE UNITED KINGDOM: A REAL-WORLD OBSERVATIONAL RETROSPECTIVE COHORT ANALYSIS

Background:

There is limited real-world evidence describing the presentation and treatment patterns of systemic lupus erythematosus (SLE) in the United Kingdom (UK).

Objectives:

To characterize disease severity, comorbid conditions, treatment patterns, and flares in a longitudinal cohort of adults with SLE in the UK.

Methods:

Patients aged ≥18 years with SLE were identified in the Clinical Practice Research Datalink – Hospital Episode Statistics database from January 1, 2005, to December 31, 2017. Patients were required to have ≥12 months of data before and after index date (date of earliest SLE diagnosis available). SLE disease severity and flares were classified as mild, moderate, or severe using adapted claims-based algorithms1,2that use SLE-related conditions (eg, end-stage renal disease), medications (eg, antimalarials, immunosuppressants, and corticosteroids), and health service use (eg, hospitalizations and emergency department visits).

Results:

Of 802 patients with SLE, 369 (46.0%) had mild, 345 (43.0%) had moderate, and 88 (11.0%) had severe SLE at baseline. In total, 692 (86.3%) patients were treated with SLE medications in the first year after SLE diagnosis. Among the total population (802), 557 (69.5%) patients received antimalarials, 203 (25.3%) received immunosuppressants, and 416 (51.9%) received corticosteroids (prednisolone); patients may have received ≥1 type of drug. Information on biologic use in hospitals is unavailable in these data. The mean (standard deviation [SD]) time to initiating any medication from index date was 177 (385.3) days (Figure 1A). The median time to first flare from index date was 63 days (95% confidence interval 57–71) (Figure 1B). A majority of patients (750/802, 93.5%) experienced ≥1 flare during follow-up; the first flare was mild for 73.2% of patients (549/750), moderate for 15.5% (116/750), and severe for 11.3% (85/750). The mean (SD) annual overall flare rate in the first year after index date was 3.5 (2.5) (mild flares: 2.6 [2.5]; moderate flares: 0.7 [1.5]; severe flares: 0.2 [0.6]) (Figure 2). A shorter median time to first flare was significantly associated with moderate or severe disease (P<0.001) and the presence of comorbid conditions (P<0.001).

Conclusion:

Our findings suggest some delay in SLE treatment initiation in the UK. Most patients with SLE experience flares within 2 months from diagnosis. Early treatment may delay or reduce the severity of the first SLE flare after diagnosis and may translate to slower disease progression, lower organ damage accrual, and better outcomes.

References:

[1]Garris C, et al.J Med Econ. 2013;16:667–77.

[2]Nightingale AL, et al.Lupus Sci Med. 2017;4:e000172.

Disclosure of Interests:

Julia Langham Consultant of: AstraZeneca, Volkan Barut Employee of: AstraZeneca, Mihail Samnaliev Consultant of: AstraZeneca, Sue Langham Consultant of: AstraZeneca, Sharada Weir Consultant of: AstraZeneca, Xia Wang Employee of: AstraZeneca, Barnabas Desta Employee of: AstraZeneca, Edward R. Hammond Employee of: AstraZeneca

THU0550 HEALTH CARE UTILIZATION AND COSTS IN ADULTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS IN THE UNITED KINGDOM: A REAL-WORLD OBSERVATIONAL RETROSPECTIVE COHORT STUDY

Background:

There is limited real-world evidence demonstrating the long-term direct costs associated with systemic lupus erythematosus (SLE) in the United Kingdom (UK).

Objectives:

To describe health care resource utilization and costs in adults with SLE in the UK over time and document costs by disease severity and type of encounter, including primary care, hospitalizations, outpatient visits, and prescription drugs.

Methods:

Patients aged ≥18 years with SLE were identified in the linked Clinical Practice Research Datalink – Hospital Episode Statistics database from January 1, 2005, to December 31, 2017. Patients were required to have data from ≥12 months before and after the index date, defined as the date of earliest diagnosis available in the data set. Patients were classified as having mild, moderate, or severe disease using an adapted claims-based algorithm.1Costs were calculated in 2017 UK pounds from the UK national health care system perspective. We estimated all-cause health care costs and incremental costs associated with each year of follow-up compared with a baseline year (3 years before index) using each patient as his or her own control and adjusting for age, sex, disease severity, and comorbid conditions.

Results:

Of the 802 patients identified, 369 (46.0%) had mild SLE, 345 (43.0%) had moderate SLE, and 88 (11.0%) had severe SLE. The mean all-cause cost increased in the 3 years before diagnosis and, in the first year after diagnosis, amounted to £7532 (standard deviation [SD] £9634). This cost varied by disease severity: mild SLE, £5221 (£8064); moderate SLE, £8323 (£9846); and severe SLE, £14,125 (£11,267) (Figure 1). Adjusted total mean annual increase in costs per patient in the overall study population was £4476 (95% confidence interval £3809–5143) greater in the year of diagnosis compared with the baseline year (P<0.0001), adjusted for age, sex, disease severity, and comorbid conditions. Primary care utilization was the leading component of costs during the first year after diagnosis, followed by prescriptions, outpatient care, and inpatient care (Figure 2). Information on biologic use in hospitals is unavailable in these data.

Conclusion:

The direct costs of health care for patients with SLE in the UK are substantial and persist over the years after diagnosis. Patients with moderate or severe SLE have higher all-cause costs over time compared with patients with mild SLE. Earlier diagnosis and treatment may reduce disease severity and occurrence of comorbidities, and the associated high health care costs.

References:

[1]Garris C, et al.J Med Econ. 2013;16:667–677.

[2]Department of Health. NHS reference costs 2017/18.https://improvement.nhs.uk/resources/reference-costs/#rc1718;2018 [accessed May 11, 2019].

Disclosure of Interests:

Mihail Samnaliev Consultant of: AstraZeneca, Volkan Barut Employee of: AstraZeneca, Sharada Weir Consultant of: AstraZeneca, Julia Langham Consultant of: AstraZeneca, Sue Langham Consultant of: AstraZeneca, Xia Wang Employee of: AstraZeneca, Barnabas Desta Employee of: AstraZeneca, Edward R. Hammond Employee of: AstraZeneca

Emergency department visits for attempted suicide and self harm in the USA: 2006-2013

AIMS

To characterise and identify nationwide trends in suicide-related emergency department (ED) visits in the USA from 2006 to 2013.

METHODS

We used data from the Nationwide Emergency Department Sample (NEDS) from 2006 to 2013. E-codes were used to identify ED visits related to suicide attempts and self-inflicted injury. Visits were characterised by factors such as age, sex, US census region, calendar month, as well as injury severity and mechanism. Injury severity and mechanism were compared between age groups and sex by chi-square tests and Wilcoxon rank-sum tests. Population-based rates were computed using US Census data.

RESULTS

Between 2006 and 2013, a total of 3 567 084 suicide attempt-related ED visits were reported. The total number of visits was stable between 2006 and 2013, with a population-based rate ranging from 163.1 to 173.8 per 100 000 annually. The frequency of these visits peaks during ages 15-19 and plateaus during ages 35-45, with a mean age at presentation of 33.2 years. More visits were by females (57.4%) than by males (42.6%); however, the age patterns for males and females were similar. Visits peaked in late spring (8.9% of all visits occurred in May), with a smaller peak in the fall. The most common mechanism of injury was poisoning (66.5%), followed by cutting and piercing (22.1%). Males were 1.6 times more likely than females to use violent methods to attempt suicide (OR = 1.64; 95% CI = 1.60-1.68; p < 0.001). The vast majority of patients (82.7%) had a concurrent mental disorder. Mood disorders were the most common (42.1%), followed by substance-related disorders (12.1%), alcohol-related disorders (8.9%) and anxiety disorders (6.4%).

CONCLUSIONS

The annual incidence of ED visits for attempted suicide and self-inflicted injury in the NEDS is comparable with figures previously reported from other national databases. We highlighted the value of the NEDS in allowing us to look in depth at age, sex, seasonal and mechanism patterns. Furthermore, using this large national database, we confirmed results from previous smaller studies, including a higher incidence of suicide attempts among women and individuals aged 15-19 years, a large seasonal peak in suicide attempts in the spring, a predominance of poisoning as the mechanism of injury for suicide attempts and a greater use of violent mechanisms in men, suggesting possible avenues for further research into strategies for prevention.

Thalidomide for acute treatment of neurosarcoidosis

STUDY DESIGN

Case report.

CLINICAL SETTING

Johns Hopkins University School of Medicine, Baltimore, MD, USA.

CASE REPORT

Sarcoidosis is a multi-system granulomatous disease of unknown etiology with worldwide distribution. The involvement of the nervous system is common-neurosarcoidosis. Immune responses play an important role in the inflammatory process and granuloma formation. We report a case of neurosarcoidosis that was refractory to two courses of intravenous steroids. Upon initiation of oral thalidomide, the patient showed dramatic improvement clinically and on magnetic resonance imaging.

CONCLUSION

Thalidomide is an immunomodulatory agent that acts to inhibit production of tumor-necrosis factor-alpha (TNF-alpha), an important mediator in CNS inflammation, by enhancing TNF-alpha mRNA degradation. Corticosteroids have been the mainstay of treatment of neurosarcoidosis with success at halting progression of the immune process in 50% cases. Thalidomide offers unique opportunities at managing CNS inflammation due to neurosarcoidosis.

DISCLOSURES

None.

Trypsin enhances sympathetic neuron-dependent plasma extravasation in the rat knee joint

Perfusion of 6-hydroxydopamine through the rat knee joint causes an increase in plasma extravasation by activation of sympathetic neuron terminals. Similarly, the increase in plasma extravasation in the rat knee joint produced by the inflammatory mediator bradykinin is dependent on the sympathetic post-ganglion neuron. There is evidence that both 6-hydroxydopamine and bradykinin release a number of mediators, some of which appear to enhance plasma extravasation and some which inhibit it. We attempted to determine the nature of inhibitory factor(s) by co-infusing trypsin (which rapidly cleaves peptides) with 6-hydroxydopamine. We observed a marked enhancement of 6-hydroxydopamine-induced plasma extravasation by trypsin. This effect appeared to be specific to neurogenic plasma extravasation since trypsin alone had little effect on plasma extravasation and trypsin did not affect non-neurogenic plasma extravasation (that produced by platelet activating factor). Taken together, the data suggests that 6-hydroxydopamine not only releases mediators from the sympathetic neuron that produce plasma extravasation, but also an inhibitor(s) of plasma extravasation that is peptide in nature.