Independent associations of lymphopenia and neutropenia in patients with systemic lupus erythematosus: a longitudinal, multinational study

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 2013–18, were used. Predictors of lymphopenia (lymphocyte count < 0.8 x 109/l) and neutropenia (neutrophil count < 1.5 x 109/l) were examined using multiple failure, time-dependent survival analyses. Results Data from 2,330 patients and 18 287 visits were analysed. One thousand three hundred twelve patients (43.7%) had at least one episode of leucopenia. 867 patients (37.2%) had lymphopenia, observed in 3,065 (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, azathioprine, methotrexate, tacrolimus, cyclophosphamide and rituximab use. Methotrexate and ciclosporin were negatively associated with neutropenia. Lupus low disease activity state (LLDAS) 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.

Association of one-point glucocorticoid-free status with chronic damage and disease duration in systemic lupus erythematosus: a cross-sectional study

“…Recent cohort studies have shown that 20%–30% of patients with SLE do not receive GCs 4 5. Hydroxychloroquine use was less frequent in this study than in recent cohort studies (27% vs 60%–74%) because hydroxychloroquine use for SLE was approved just 6 years ago in Japan.…”

“…Although a recent randomised controlled trial showed that GC withdrawal increases relapse risk in patients with SLE, 73% of patients without GC use could maintain remission 2. Another observational study showed that GC withdrawal was attempted in 91 patients, with 85% successfully withdrawing from GCs and maintaining remission,3 whereas recent cohort studies showed that only 20%–30% of patients with SLE had not taken any GCs 4 5. Previous reports have shown that younger age, disease activity and short disease duration are risk factors for relapse in GC-free patients 6–8.…”

The Clinical Characteristics of Leukopenia in Patients with Systemic Lupus Erythematosus of Han Ethnicity in China: A Cross-Sectional Study

“…In another study, SLE patients with leukopenia also had an increased incidence of lymphopenia, thrombocytopenia, hemolytic anemia, anti-dsDNA antibody positivity, lupus anticoagulant and psychosis [ 15 ]. Recent research showed that leukopenia was associated with anti-dsDNA antibody positivity, low complement and ESR ≥ 25 mm/H [ 16 ]. We speculated that the correlation between leukopenia and other parameters may be due to the fact that neutropenia or lymphopenia was related to these parameters.…”

Exposure levels of mycophenolic acid are associated with comorbidities in children with systemic lupus erythematosus

“…It was reported by a previous study that lymphopenia is associated with increased disease activity of SLE. 33 On the other hand, better disease control is associated with lower incidence of comorbidities. 6,8 Therefore, this type of connection makes the inverse association between lymphocyte percentage and comorbidities possible.…”