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Patients With Lupus Living Longer, Aggressive Use of Immunosuppressants May Be the Reason: Presented at ACR

By Paula Moyer

SAN DIEGO, CA -- November 21, 2005 -- People with systemic lupus erythematosus (SLE) are surviving much longer than they were 35 years ago, according to investigators who presented findings here at the American College of Rheumatology Annual Scientific Meeting (ACR).

"People are not dying of lupus as early, and we may be coming up with better strategies for treatment," said lead investigator Murray B. Urowitz, MD, in a briefing on November 17^th. "More aggressive use of immunosuppressants and other therapies, even with reduced steroid use, may be having an impact."

Dr. Urowitz is director of the Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada.

Although clinicians have been using the same treatments for lupus for the past 30 years, patients' survival has improved. The team felt that it needed to examine other outcomes besides survival as well as medication use.

They retrieved data from a cohort of 1184 patients Ontario residents with lupus who were registered in a longitudinal observational cohort study from 1970 to 2005. In the study, patients undergo clinical and laboratory evaluation at intervals of 2 to 6 months.

For their analysis, Dr. Urowitz and colleagues divided the cohort into 4 groups according to the year of entry into the study: 1970 to 1978, from 1979 to 1987, those entering from 1988 to 1996, and those entering from 1997 to 2005.

The investigators evaluated the disease status of patients at the end of each time span. At those time points, they calculated patients' standardized mortality ratios based on that of the general population of Ontario and investigated both a cohort effect and a calendar effect. They also assessed medication use, disease activity, and systemic impact of the disease.

In the first time period, the standardized mortality ratio was 14.4 compared with that of the general population of Ontario. In the second time period, the mortality ratio had decreased to 6.93. In the last 2 time periods, mortality was 4.52 and 3.27, respectively.

Among subjects enrolled during the first time period, 14.0% had died, compared with 8.3% for the second time period, 3.8% for the third, and 1.8% for the final time period (P < .0001 for trend).

The investigators observed differences in treatment strategies that could have affected survival in the 4 time groups, Dr. Urowitz said. Immunosuppressants were used by 27.6% of patients in the first time period, and by 25.4% in the second time period. In the last 2 time periods, the rate had increased to 41.3% and 55.3%, respectively (P < .0001).

Steroids were used by, 83%, 69.7%. 74.6%, and 79.6%, respectively. The cumulative dose of steroids decreased from a high of 19.7 g in the first time period to 15.8 g in the final time period (P = .0028).

In the first 3 time periods, the average age at presentation was 35.2 to 35.8 years, but in the last time period, the average age had decreased to 32.5 years. Dr. Urowitz noted that although patients recruited in the most recent time period had had their disease for an average of 4.7 years, in the preceding time periods, the disease duration ranged from 3.2 to 3.7 years.


[Presentation Title: Changing Outcomes in SLE Over 35 Years. Abstract 1957]

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