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Risk factors of disease flares in a Chinese lupus cohort with low-grade disease activity

OBJECTIVE: Recurrent disease flare is one of the key problems in lupus patients. A Chinese Flare-Prevention Lupus Initiative Cohort (FLIC) was established. Risk factors of disease flare were evaluated accordingly. METHODS: Patients with low-grade disease activity (the Safety of Estrogens in Lupus Er...

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Autores principales: Sun, Fangfang, Zhao, Liling, Wang, Haiting, Zhang, Danting, Chen, Jie, Wang, Xiaodong, Li, Ting, Ye, Shuang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9125751/
https://www.ncbi.nlm.nih.gov/pubmed/35606018
http://dx.doi.org/10.1136/lupus-2022-000657
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author Sun, Fangfang
Zhao, Liling
Wang, Haiting
Zhang, Danting
Chen, Jie
Wang, Xiaodong
Li, Ting
Ye, Shuang
author_facet Sun, Fangfang
Zhao, Liling
Wang, Haiting
Zhang, Danting
Chen, Jie
Wang, Xiaodong
Li, Ting
Ye, Shuang
author_sort Sun, Fangfang
collection PubMed
description OBJECTIVE: Recurrent disease flare is one of the key problems in lupus patients. A Chinese Flare-Prevention Lupus Initiative Cohort (FLIC) was established. Risk factors of disease flare were evaluated accordingly. METHODS: Patients with low-grade disease activity (the Safety of Estrogens in Lupus Erythematosus National Assessment–SLE Disease Activity Index (SELENA-SLEDAI) =≤6, daily prednisone ≤20 mg, no British Isles Lupus Assessment Group A or no more than one B organ domain score) from January 2014 to August 2020 were included in the FLIC. Disease flares were defined by the modified SELENA-­SLEDAI Flare Index. Low disease activity status (LDAS) and remission were also assessed. The cumulative flare rate was estimated by an event per 100 person-years analysis. Cox proportional hazards models were performed to identify risk factors of subsequent disease flares after adjusting clinical confounders. Survival was assessed with the Kaplan-Meier method. RESULTS: 448 eligible patients with low-grade disease activity were included in FLIC. During a mean follow-up of 30.4 months, 170 patients flared. The cumulative lupus flare rate was 22.2 events per 100 patient-years. Compared with patients without flare, those with lupus flares were taking more prednisone, had higher disease activity index and with less patients attained LDAS/remission at baseline. They also had higher rates of antiphospholipid antibodies (aPLs) and antiribosomal P antibody. Cox regression analysis confirmed that attainment of either LDAS or remission at baseline were independent protective factors against subsequent disease flare (LDAS but not in remission: HR 0.58, 95% CI 0.38~0.88; remission: HR 0.46, 95% CI 0.30~0.69), while aPL was a risk factor of lupus flares (HR 1.95, 95% CI 1.36~2.78). Kaplan-Meier curves indicated that attaining LDAS or remission and absence of aPL at baseline had the least flare risk. CONCLUSIONS: In our real-world cohort study, not attaining LDAS or remission at baseline and aPL positivity was associated with higher risk of disease flares in patients with low-grade SLE.
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spelling pubmed-91257512022-06-04 Risk factors of disease flares in a Chinese lupus cohort with low-grade disease activity Sun, Fangfang Zhao, Liling Wang, Haiting Zhang, Danting Chen, Jie Wang, Xiaodong Li, Ting Ye, Shuang Lupus Sci Med Epidemiology and Outcomes OBJECTIVE: Recurrent disease flare is one of the key problems in lupus patients. A Chinese Flare-Prevention Lupus Initiative Cohort (FLIC) was established. Risk factors of disease flare were evaluated accordingly. METHODS: Patients with low-grade disease activity (the Safety of Estrogens in Lupus Erythematosus National Assessment–SLE Disease Activity Index (SELENA-SLEDAI) =≤6, daily prednisone ≤20 mg, no British Isles Lupus Assessment Group A or no more than one B organ domain score) from January 2014 to August 2020 were included in the FLIC. Disease flares were defined by the modified SELENA-­SLEDAI Flare Index. Low disease activity status (LDAS) and remission were also assessed. The cumulative flare rate was estimated by an event per 100 person-years analysis. Cox proportional hazards models were performed to identify risk factors of subsequent disease flares after adjusting clinical confounders. Survival was assessed with the Kaplan-Meier method. RESULTS: 448 eligible patients with low-grade disease activity were included in FLIC. During a mean follow-up of 30.4 months, 170 patients flared. The cumulative lupus flare rate was 22.2 events per 100 patient-years. Compared with patients without flare, those with lupus flares were taking more prednisone, had higher disease activity index and with less patients attained LDAS/remission at baseline. They also had higher rates of antiphospholipid antibodies (aPLs) and antiribosomal P antibody. Cox regression analysis confirmed that attainment of either LDAS or remission at baseline were independent protective factors against subsequent disease flare (LDAS but not in remission: HR 0.58, 95% CI 0.38~0.88; remission: HR 0.46, 95% CI 0.30~0.69), while aPL was a risk factor of lupus flares (HR 1.95, 95% CI 1.36~2.78). Kaplan-Meier curves indicated that attaining LDAS or remission and absence of aPL at baseline had the least flare risk. CONCLUSIONS: In our real-world cohort study, not attaining LDAS or remission at baseline and aPL positivity was associated with higher risk of disease flares in patients with low-grade SLE. BMJ Publishing Group 2022-05-19 /pmc/articles/PMC9125751/ /pubmed/35606018 http://dx.doi.org/10.1136/lupus-2022-000657 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Epidemiology and Outcomes
Sun, Fangfang
Zhao, Liling
Wang, Haiting
Zhang, Danting
Chen, Jie
Wang, Xiaodong
Li, Ting
Ye, Shuang
Risk factors of disease flares in a Chinese lupus cohort with low-grade disease activity
title Risk factors of disease flares in a Chinese lupus cohort with low-grade disease activity
title_full Risk factors of disease flares in a Chinese lupus cohort with low-grade disease activity
title_fullStr Risk factors of disease flares in a Chinese lupus cohort with low-grade disease activity
title_full_unstemmed Risk factors of disease flares in a Chinese lupus cohort with low-grade disease activity
title_short Risk factors of disease flares in a Chinese lupus cohort with low-grade disease activity
title_sort risk factors of disease flares in a chinese lupus cohort with low-grade disease activity
topic Epidemiology and Outcomes
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9125751/
https://www.ncbi.nlm.nih.gov/pubmed/35606018
http://dx.doi.org/10.1136/lupus-2022-000657
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