Damage accrual and mortality over long-term follow-up in 300 patients with systemic lupus erythematosus in a multi-ethnic British cohort

Segura, Beatriz Tejera; Bernstein, Brett Sydney; McDonnell, Thomas; Wincup, Chris; Ripoll, Vera M.; Giles, Ian; Isenberg, David; Rahman, Anisur

doi:10.1093/rheumatology/kez516

Cited by 40 publications

(21 citation statements)

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“…2,4 A longer disease duration is considered an independent risk factor for mortality, as corroborated in a multi-ethnic SLE cohort followed for up to 40 years, in which the cumulative incidence of death was 29%, strongly associated with damage accrual and target organ damage such as renal involvement. 11 In the latter, sepsis was the main cause of death, followed by cancer and cardiovascular events. The causes of death in our study follow a similar pattern, also associated to higher damage accrual.…”

Section: Discussionmentioning

confidence: 99%

Rubrics for mortality: a real-world observational long-term lupus nephritis cohort

Moraes-Fontes

Ferreira

Riso

et al. 2020

Lupus

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In this study, we aimed to evaluate long-term patient survival according to demographic data, clinical manifestations of systemic lupus erythematosus (SLE) and previous and current treatments, collected retrospectively. Patient selection required a minimum of four American College of Rheumatology revised criteria for SLE, biopsy-proven lupus nephritis (LN) available for reclassification according to the modified National Institutes of Health proposal for activity and chronicity indices and a minimum follow-up of at least three years since the last renal biopsy. Selection criteria were fulfilled in 25 patients followed for a median of 21 years. Based on the last renal biopsy, an equal number of patients were thus classified as class I/II and IV ( n=8) and class III and V ( n = 4). The mortality rate for LN was 14%. Having ever been diagnosed with glomerulonephritis (GN) type III or type IV but not class IV alone ( p = 0.046), a higher histological chronicity index at the last renal biopsy ( p = 0.022), not attaining renal remission one year after induction therapy ( p = 0.004), end-stage renal disease on dialysis ( p = 0.033) and the extra-renal Systemic Lupus International Collaborating Clinics Damage Index score ( p = 0.017) were all significantly associated with mortality. Our results may provide important clues for strict observation protocols in particular categories of LN patients with long-standing disease.

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Section: Discussionmentioning

confidence: 99%

Rubrics for mortality: a real-world observational long-term lupus nephritis cohort

Moraes-Fontes

Ferreira

Riso

et al. 2020

Lupus

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“…[9][10][11] It has been well documented that disease activity, steroid use, and organ damage increase mortality risk in patients with SLE. [12][13][14][15][16] Therefore, a major goal of long-term SLE management is to prevent flares while minimizing toxicity of treatments. 1,2 Anifrolumab, a human immunoglobulin G1OE antibody that binds the type I interferon (IFN) receptor, [17][18][19] has been shown to reduce disease activity in patients with SLE.…”

Section: Introductionmentioning

confidence: 99%

Anifrolumab reduces flare rates in patients with moderate to severe systemic lupus erythematosus

Furie

Morand

Askanase

et al. 2021

Lupus

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Background Systemic lupus erythematosus (SLE) management objectives include preventing disease flares while minimizing glucocorticoid exposure. Pooled data from the phase 3 TULIP-1 and TULIP-2 trials in patients with moderate to severe SLE were analyzed to determine anifrolumab’s effect on flares, including those arising with glucocorticoid taper. Methods TULIP-1 and TULIP-2 were randomized, placebo-controlled, 52-week trials of intravenous anifrolumab (300 mg every 4 weeks for 48 weeks). For patients receiving baseline glucocorticoid ≥10 mg/day, attempted taper to ≤7.5 mg/day prednisone or equivalent from Weeks 8–40 was required and defined as sustained reduction when maintained through Week 52. Flares were defined as ≥1 new BILAG-2004 A or ≥2 new BILAG-2004 B scores versus the previous visit. Flare assessments were compared for patients receiving anifrolumab versus placebo. Results Compared with placebo (n = 366), anifrolumab (n = 360) was associated with lower annualized flare rates (rate ratio 0.75, 95% confidence interval [CI] 0.60–0.95), prolonged time to first flare (hazard ratio 0.70, 95% CI 0.55–0.89), and fewer patients with ≥1 flare (difference −9.3%, 95% CI −16.3 to −2.3), as well as flares in organ domains commonly active at baseline (musculoskeletal, mucocutaneous). Fewer BILAG-based Composite Lupus Assessment responders had ≥1 flare with anifrolumab (21.1%, 36/171) versus placebo (30.4%, 34/112). Of patients who achieved sustained glucocorticoid reductions from ≥10 mg/day at baseline, more remained flare free with anifrolumab (40.0%, 76/190) versus placebo (17.3%, 32/185). Conclusions Analyses of pooled TULIP-1 and TULIP-2 data support that anifrolumab reduces flares while permitting glucocorticoid taper in patients with SLE. ClinicalTrials.gov identifiers TULIP-1 NCT02446912 (clinicaltrials.gov/ct2/show/NCT02446912); TULIP-2 NCT02446899 (clinicaltrials.gov/ct2/show/NCT02446899).

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“…It is highly variable disease in terms of both clinical symptoms and immunological profile [ 2 ]. The wide-ranging clinical manifestations of SLE include rash [often associated with photosensitivity], arthralgia and arthritis [ 3 ], alopecia, mucosal ulceration, and fevers [ 4 ]. The most severe manifestations of the disease typically result from end organ involvement such as renal disease [lupus nephritis] [ 5 ], neurological involvement [ 6 ], cardiac [ 7 ] and pulmonary disease [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Pathological mechanisms of abnormal iron metabolism and mitochondrial dysfunction in systemic lupus erythematosus

Wincup

Sawford

Rahman

2021

Expert Review of Clinical Immunology

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Introduction: Systemic lupus erythematosus [SLE] is a chronic, autoimmune condition characterized by the formation of autoantibodies directed against nuclear components and by oxidative stress. Recently, a number of studies have demonstrated the essential role of iron in the immune response and there is growing evidence that abnormal iron homeostasis can occur in the chronic inflammatory state seen in SLE. Not only is iron vital for hematopoiesis, it is also important for a number of other key physiological processes, in particular in maintaining healthy mitochondrial function. Areas covered: In this review, we highlight the latest understanding with regards to how patients with SLE may be at risk of cellular iron depletion as a result of both absolute and functional iron deficiency. Furthermore, we aim to explain the latest evidence of mitochondrial dysfunction in the pathogenesis of the disease. Expert opinion: Growing evidence suggests that both abnormal iron homeostasis and subsequent mitochondrial dysfunction can impair effector immune cell function. Through a greater understanding of these abnormalities, therapeutic options that directly target iron and mitochondria may ultimately represent novel treatment targets that may translate into clinical care of patients with SLE in the near future.

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Damage accrual and mortality over long-term follow-up in 300 patients with systemic lupus erythematosus in a multi-ethnic British cohort

Cited by 40 publications

References 0 publications

Rubrics for mortality: a real-world observational long-term lupus nephritis cohort

Rubrics for mortality: a real-world observational long-term lupus nephritis cohort

Anifrolumab reduces flare rates in patients with moderate to severe systemic lupus erythematosus

Pathological mechanisms of abnormal iron metabolism and mitochondrial dysfunction in systemic lupus erythematosus

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