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Are We Treating SLE Well Enough?

February 13 2015 11:03 AM ET via RheumReports RheumReports

Dr. Christine Peschken presented a poster at the CRA titled: ‘Residual Lupus Disease Activity in a Large Canadian Cohort of Prevalent Patients.’ This study analyzed patients with SLE from the 1000 Faces of Lupus cohort (a prevalent and incident cohort of patients followed annually at many Canadian sites). The premise for this study is that if we can effectively control SLE disease activity, there should be less damage.

The study included 1454 SLE patients with a mean age of 44 years and 11 years of disease duration. 90% were women, two thirds were Caucasians and an astounding 1 in 5 had not obtained a high school diploma. Half the patients had low disease activity, a fifth had moderate activity and a sixth had high disease activity as measured by the SLE Disease Activity Index (SLEDAI2K). There were no differences in age, sex or education between the low and moderate vs. active and highly active groups whereas the SLE disease duration was lower in those with high disease activity.

As expected, cyclophosphamide and steroids were used more often in patients with high disease activity but antimalarials were used less in the highly active group. Somewhat unexpectedly, just over half of the low and moderate disease activity patients were using prednisone at doses greater than 7.5 mg/day.

SLE damage as measured by the SLE Damage Index (SDI) was slightly higher in the groups with higher disease activity, suggesting an accumulation of damage over time from previous disease activity.

This study raises several questions, especially about the use of steroids. Are we using steroids too much in SLE? The lower disease activity groups likely needed steroids to get them well, but could they be tapered without a flare? Are other immune suppressants under-used that would allow for steroid sparing? Is this the right proportion of patients to be on steroids since they may be able to maintain a low disease state but it is their long-term complications that are worrisome?

We do know from RCTs that enrolled SLE patients with active disease that steroid use is over 50%. Future research should consider strategies to limit steroid use (dose and duration) while maintaining low disease states.

See RheumReports for a summary on related by Dr. Touma's work with the Toronto SLE cohort where he presented data at this meeting about discontinuation of background SLE treatment in patients who were in remission.

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About the Author

Dr. Janet Pope
Dr. Janet Pope

Dr. Janet Pope is Professor of Medicine at Western University and Division Head of Rheumatology. Dr. Pope's research interests include epidemiologic studies in scleroderma, classification criteria in systemic sclerosis, systemic lupus erythematosus and rheumatoid arthritis.

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