Contributors to Organ Damage in Childhood Lupus: Corticosteroid Use and Disease Activity.
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Authors
Hanif, Maria
Sarker, Chandni
Al-Abadi, Eslam
Armon, Kate
Bailey, Kathryn
Bohm, Marek
Brennan, Mary
Ciurtin, Coziana
Gardner-Medwin, Janet
Hawley, Daniel P
Issue Date
2024-10-22
Type
Journal Article
Language
en
Keywords
Childhood-SLE , corticosteroids , damage , low disease activity , treat-to-target
Alternative Title
Abstract
Background: Awareness of paediatric-specific predictors of damage in Childhood-lupus is needed to inform mitigation measures.
Objectives: To ascertain how clinical and demographic variables correlate with damage accrual and identify predictors of damage.
Methods: Analysis included UK JSLE Cohort Study participants. Univariable and multivariable Prentice-Williams-Peterson models investigated how demographic and clinical factors influenced hazards of new damage. Analyses were performed across the entire cohort, in patients with minimal disease activity marked by a time-adjusted average SLEDAI-2K score (AMS)≤2, low activity (AMS ≤ 4), moderate-high activity (AMS > 4) and those with no corticosteroids.
Results: Within the entire cohort (n = 430), factors associated with damage included: any methylprednisolone (Hazard Ratio, HR 2.20, [CI 1.33-3.62]), time-adjusted mean Physicians Global Assessment (PGA) (HR 2.87, [CI 1.48-5.56]) and AMS score (HR 1.13, [CI 1.03-1.24], all p< 0.05). Within the low activity subgroup, any methylprednisolone (HR 2.61, [CI 1.04-6.53]) and time-adjusted mean PGA (HR 3.41, [CI 1.52-7.76]) were associated with damage (both p< 0.05). Within the moderate-high activity subgroup, any methylprednisolone (HR 2.29, [CI 1.31-4.00]), time-adjusted mean PGA (HR 2.66, [CI 1.20-5.87]) and AMS score (HR 1.15, [CI 1.03-1.29]), were predictive of damage (all p< 0.05). Baseline organ damage was predictive of subsequent damage accrual in the minimal activity (HR 1.33, CI [1.78-8.08]) and no corticosteroids subgroups (HR 3.64, CI [1.83-7.24], both p< 0.005).
Conclusion: Disease activity levels (AMS/PGA) and proxy indicators (methylprednisolone exposure, baseline damage) were found to be key predictors of damage accrual. This highlights the importance of practical strategies, to reduce disease activity and long-term treatment toxicity, such as treat-to-target.
Keywords: Childhood-SLE; corticosteroids; damage; low disease activity; treat-to-target.
Description
Citation
Hanif, M.; Sarker, C.; Al-Abadi, E.; et al. (2024) 'Contributors to organ damage in childhood lupus: corticosteroid use and disease activity', Rheumatology. Available at: https://doi.org/10.1093/rheumatology/keae592
Publisher
Oxford Academic
License
© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology.
Journal
Rheumatology (Oxford, England)
Volume
Issue
PubMed ID
ISSN
1462-0332