scholarly journals SAT0216 DISEASE SEVERITY, COMORBID CONDITIONS, TREATMENT PATTERNS, AND FLARES IN ADULTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS IN THE UNITED KINGDOM: A REAL-WORLD OBSERVATIONAL RETROSPECTIVE COHORT ANALYSIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1050.3-1051
Author(s):  
J. Langham ◽  
V. Barut ◽  
M. Samnaliev ◽  
S. Langham ◽  
S. Weir ◽  
...  
Keyword(s):  
Disease Severity ◽  
Lupus Erythematosus ◽  
Index Date ◽  
Treatment Patterns ◽  
First Year ◽  
Comorbid Conditions ◽  
Systemic Lupus ◽  
The United Kingdom ◽  
The Mean ◽  
The Uk

Background:There is limited real-world evidence describing the presentation and treatment patterns of systemic lupus erythematosus (SLE) in the United Kingdom (UK).Objectives:To characterize disease severity, comorbid conditions, treatment patterns, and flares in a longitudinal cohort of adults with SLE in the UK.Methods:Patients aged ≥18 years with SLE were identified in the Clinical Practice Research Datalink – Hospital Episode Statistics database from January 1, 2005, to December 31, 2017. Patients were required to have ≥12 months of data before and after index date (date of earliest SLE diagnosis available). SLE disease severity and flares were classified as mild, moderate, or severe using adapted claims-based algorithms1,2that use SLE-related conditions (eg, end-stage renal disease), medications (eg, antimalarials, immunosuppressants, and corticosteroids), and health service use (eg, hospitalizations and emergency department visits).Results:Of 802 patients with SLE, 369 (46.0%) had mild, 345 (43.0%) had moderate, and 88 (11.0%) had severe SLE at baseline. In total, 692 (86.3%) patients were treated with SLE medications in the first year after SLE diagnosis. Among the total population (802), 557 (69.5%) patients received antimalarials, 203 (25.3%) received immunosuppressants, and 416 (51.9%) received corticosteroids (prednisolone); patients may have received ≥1 type of drug. Information on biologic use in hospitals is unavailable in these data. The mean (standard deviation [SD]) time to initiating any medication from index date was 177 (385.3) days (Figure 1A). The median time to first flare from index date was 63 days (95% confidence interval 57–71) (Figure 1B). A majority of patients (750/802, 93.5%) experienced ≥1 flare during follow-up; the first flare was mild for 73.2% of patients (549/750), moderate for 15.5% (116/750), and severe for 11.3% (85/750). The mean (SD) annual overall flare rate in the first year after index date was 3.5 (2.5) (mild flares: 2.6 [2.5]; moderate flares: 0.7 [1.5]; severe flares: 0.2 [0.6]) (Figure 2). A shorter median time to first flare was significantly associated with moderate or severe disease (P<0.001) and the presence of comorbid conditions (P<0.001).Conclusion:Our findings suggest some delay in SLE treatment initiation in the UK. Most patients with SLE experience flares within 2 months from diagnosis. Early treatment may delay or reduce the severity of the first SLE flare after diagnosis and may translate to slower disease progression, lower organ damage accrual, and better outcomes.References:[1]Garris C, et al.J Med Econ. 2013;16:667–77.[2]Nightingale AL, et al.Lupus Sci Med. 2017;4:e000172.Disclosure of Interests:Julia Langham Consultant of: AstraZeneca, Volkan Barut Employee of: AstraZeneca, Mihail Samnaliev Consultant of: AstraZeneca, Sue Langham Consultant of: AstraZeneca, Sharada Weir Consultant of: AstraZeneca, Xia Wang Employee of: AstraZeneca, Barnabas Desta Employee of: AstraZeneca, Edward R. Hammond Employee of: AstraZeneca

THU0550 HEALTH CARE UTILIZATION AND COSTS IN ADULTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS IN THE UNITED KINGDOM: A REAL-WORLD OBSERVATIONAL RETROSPECTIVE COHORT STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 515-516
Author(s):  
M. Samnaliev ◽  
V. Barut ◽  
S. Weir ◽  
J. Langham ◽  
S. Langham ◽  
...  
Keyword(s):  
Health Care ◽  
Disease Severity ◽  
Lupus Erythematosus ◽  
Direct Costs ◽  
Care Utilization ◽  
First Year ◽  
Comorbid Conditions ◽  
The United Kingdom ◽  
The Uk ◽  
Care Costs

Background:There is limited real-world evidence demonstrating the long-term direct costs associated with systemic lupus erythematosus (SLE) in the United Kingdom (UK).Objectives:To describe health care resource utilization and costs in adults with SLE in the UK over time and document costs by disease severity and type of encounter, including primary care, hospitalizations, outpatient visits, and prescription drugs.Methods:Patients aged ≥18 years with SLE were identified in the linked Clinical Practice Research Datalink – Hospital Episode Statistics database from January 1, 2005, to December 31, 2017. Patients were required to have data from ≥12 months before and after the index date, defined as the date of earliest diagnosis available in the data set. Patients were classified as having mild, moderate, or severe disease using an adapted claims-based algorithm.1Costs were calculated in 2017 UK pounds from the UK national health care system perspective. We estimated all-cause health care costs and incremental costs associated with each year of follow-up compared with a baseline year (3 years before index) using each patient as his or her own control and adjusting for age, sex, disease severity, and comorbid conditions.Results:Of the 802 patients identified, 369 (46.0%) had mild SLE, 345 (43.0%) had moderate SLE, and 88 (11.0%) had severe SLE. The mean all-cause cost increased in the 3 years before diagnosis and, in the first year after diagnosis, amounted to £7532 (standard deviation [SD] £9634). This cost varied by disease severity: mild SLE, £5221 (£8064); moderate SLE, £8323 (£9846); and severe SLE, £14,125 (£11,267) (Figure 1). Adjusted total mean annual increase in costs per patient in the overall study population was £4476 (95% confidence interval £3809–5143) greater in the year of diagnosis compared with the baseline year (P<0.0001), adjusted for age, sex, disease severity, and comorbid conditions. Primary care utilization was the leading component of costs during the first year after diagnosis, followed by prescriptions, outpatient care, and inpatient care (Figure 2). Information on biologic use in hospitals is unavailable in these data.Conclusion:The direct costs of health care for patients with SLE in the UK are substantial and persist over the years after diagnosis. Patients with moderate or severe SLE have higher all-cause costs over time compared with patients with mild SLE. Earlier diagnosis and treatment may reduce disease severity and occurrence of comorbidities, and the associated high health care costs.References:[1]Garris C, et al.J Med Econ. 2013;16:667–677.[2]Department of Health. NHS reference costs 2017/18.https://improvement.nhs.uk/resources/reference-costs/#rc1718;2018 [accessed May 11, 2019].Disclosure of Interests:Mihail Samnaliev Consultant of: AstraZeneca, Volkan Barut Employee of: AstraZeneca, Sharada Weir Consultant of: AstraZeneca, Julia Langham Consultant of: AstraZeneca, Sue Langham Consultant of: AstraZeneca, Xia Wang Employee of: AstraZeneca, Barnabas Desta Employee of: AstraZeneca, Edward R. Hammond Employee of: AstraZeneca

scholarly journals Healthcare utilization and costs in adults with SLE in the United Kingdom: a real-world observational retrospective cohort analysis

2021 ◽  
Author(s):  
Mihail Samnaliev ◽  
Volkan Barut ◽  
Sharada Weir ◽  
Julia Langham ◽  
Sue Langham ◽  
...  
Keyword(s):  
Disease Severity ◽  
Healthcare Costs ◽  
Severe Disease ◽  
Cohort Analysis ◽  
Practice Research ◽  
Future Research ◽  
First Year ◽  
Clinical Practice Research Datalink ◽  
Comorbid Conditions ◽  
The Uk

Abstract Objectives To describe direct healthcare costs for adults with systemic lupus erythematosus (SLE) in the UK over time and by disease severity and encounter type. Methods Patients aged ≥18 years with SLE were identified using the linked Clinical Practice Research Datalink—Hospital Episode Statistics database from January 2005 to December 2017. Patients were classified as having mild, moderate, or severe disease using an adapted claims-based algorithm based on prescriptions and comorbid conditions. We estimated all-cause healthcare costs and incremental costs associated with each year of follow-up compared with a baseline year adjusting for age, sex, disease severity, and comorbid conditions (2017 UK pounds). Results We identified 802 patients; 369 (46.0%) with mild, 345 (43.0%) moderate, and 88 (11.0%) severe disease. The mean all-cause cost increased in the 3 years before diagnosis, peaked in the first year after diagnosis and remained high. Adjusted total mean annual increase in costs per patient was £4476 (95% confidence interval £3809–5143) greater in the year of diagnosis compared with the baseline year (p &lt; 0.0001). The increase in costs per year were 4.7-fold and 1.6-fold higher among patients with severe SLE compared with those with mild and moderate SLE respectively. Primary care utilisation was the leading component of costs during the first year of diagnosis. Conclusion The healthcare costs for patients with SLE in the UK are substantial, remain high after diagnosis and increase with increasing severity. Future research should assess whether earlier diagnosis and treatment may reduce disease severity and associated high healthcare costs.

scholarly journals Disease severity, flares and treatment patterns in adults with systemic lupus erythematosus in the UK: a real-world observational retrospective cohort analysis

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Julia Langham ◽  
Volkan Barut ◽  
Mihail Samnaliev ◽  
Sue Langham ◽  
Sharada Weir ◽  
...  
Keyword(s):  
Disease Severity ◽  
Median Time ◽  
Service Use ◽  
Cohort Analysis ◽  
Clinical Manifestations ◽  
Treatment Patterns ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
The Mean ◽  
The Uk

Abstract Objectives The aim was to characterize disease severity, clinical manifestations, treatment patterns and flares in a longitudinal cohort of adults with SLE in the UK. Methods Adults with SLE were identified in the Clinical Practice Research Datalink–Hospital Episode Statistics database (1 January 2005–31 December 2017). Patients were required to have ≥12 months of data before and after the index date (earliest SLE diagnosis date available). SLE disease severity and flares were classified using adapted claims-based algorithms, which are based on SLE-related conditions, medications and health-service use. Results Of 802 patients, 369 had mild, 345 moderate and 88 severe SLE at baseline. A total of 692 initiated treatment in the first year after diagnosis. Five hundred and fifty-seven received antimalarials, 203 immunosuppressants and 416 oral CSs. Information on biologic use in hospitals was unavailable. The mean (S.d.) time to initiating any medication was 177 (385.3) days. The median time to first flare was 63 days (95% CI: 57, 71). At least one flare was experienced by 750 of 802 patients during follow-up; the first flare was mild for 549 of 750, moderate for 116 of 750 and severe for 85 of 750. The mean (S.d.) annual overall flare rate (year 1) was 3.5 (2.5). A shorter median time to first flare was significantly associated with moderate/severe disease (P &lt; 0.001) and clinical manifestations (P &lt; 0.001). Conclusion Our findings suggest some delay in the initiation of SLE treatment. Most patients experience a flare within 2 months of diagnosis. Early treatment might delay or reduce the severity of the first SLE flare and might translate to slower disease progression, lower accrual of organ damage and better outcomes.

scholarly journals Methyl donor micronutrients, CD40-ligand methylation and disease activity in systemic lupus erythematosus: A cross-sectional association study

Lupus ◽  
2021 ◽  
pp. 096120332110345
Author(s):  
Stefan Vordenbäumen ◽  
Alexander Sokolowski ◽  
Anna Rosenbaum ◽  
Claudia Gebhard ◽  
Johanna Raithel ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Dna Methylation ◽  
T Cells ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Cd40 Ligand ◽  
Systemic Lupus ◽  
Methyl Donors ◽  
Methyl Donor ◽  
The Mean

Objective Hypomethylation of CD40-ligand (CD40L) in T-cells is associated with increased disease activity in systemic lupus erythematosus (SLE). We therefore investigated possible associations of dietary methyl donors and products with CD40L methylation status in SLE. Methods Food frequency questionnaires were employed to calculate methyl donor micronutrients in 61 female SLE patients (age 45.7 ± 12.0 years, disease duration 16.2 ± 8.4 years) and compared to methylation levels of previously identified key DNA methylation sites (CpG17 and CpG22) within CD40L promotor of T-cells using quantitative DNA methylation analysis on the EpiTYPER mass spectrometry platform. Disease activity was assessed by SLE Disease Activity Index (SLEDAI). Linear regression modelling was used. P values were adjusted according to Benjamini & Hochberg. Results Amongst the micronutrients assessed (g per day), methionine and cysteine were associated with methylation of CpG17 (β = 5.0 (95%CI: 0.6-9.4), p = 0.04; and β = 2.4 (0.6-4.1), p = 0.02, respectively). Methionine, choline, and cysteine were additionally associated with the mean methylation of the entire CD40L (β = 9.5 (1.0-18.0), p = 0.04; β = 1.6 (0.4-3.0), p = 0.04; and β = 4.3 (0.9-7.7), p = 0.02, respectively). Associations of the SLEDAI with hypomethylation were confirmed for CpG17 (β=-32.6 (-60.6 to -4.6), p = 0.04) and CpG22 (β=-38.3 (-61.2 to -15.4), p = 0.004), but not the mean methylation of CD40L. Dietary products with the highest impact on methylation included meat, ice cream, white bread, and cooked potatoes. Conclusions Dietary methyl donors may influence DNA methylation levels and thereby disease activity in SLE.

scholarly journals Fatigue in patients with systemic lupus erythematosus and neuropsychiatric symptoms is associated with anxiety and depression rather than inflammatory disease activity

Lupus ◽  
2021 ◽  
pp. 096120332110050
Author(s):  
Rory C Monahan ◽  
Liesbeth JJ Beaart-van de Voorde ◽  
Jeroen Eikenboom ◽  
Rolf Fronczek ◽  
Margreet Kloppenburg ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Neuropsychiatric Symptoms ◽  
Anxiety And Depression ◽  
Systemic Lupus ◽  
Sf 36 ◽  
Neuropsychiatric Sle ◽  
Inflammatory Phenotype ◽  
The Mean

Introduction We aimed to investigate risk factors for fatigue in patients with systemic lupus erythematosus (SLE) and neuropsychiatric symptoms in order to identify potential interventional strategies. Methods Patients visiting the neuropsychiatric SLE (NPSLE) clinic of the Leiden University Medical Center between 2007–2019 were included. In a multidisciplinary consensus meeting, SLE patients were classified as having neuropsychiatric symptoms of inflammatory origin (inflammatory phenotype) or other origin (non-inflammatory phenotype). Fatigue was assessed with the SF-36 vitality domain (VT) since 2007 and the multidimensional fatigue inventory (MFI) and visual analogue scale (VAS) since 2011. Patients with a score on the SF-36 VT ≥1 standard deviation (SD) away from the mean of age-related controls of the general population were classified as fatigued; patients ≥2 SD away were classified as extremely fatigued. Disease activity was measured using the SLE disease activity index-2000. The influence of the presence of an inflammatory phenotype, disease activity and symptoms of depression and anxiety as measured by the hospital anxiety and depression scale (HADS) was analyzed using multiple regression analyses corrected for age, sex and education. Results 348 out of 371 eligible patients filled in questionnaires and were included in this study . The majority was female (87%) and the mean age was 43 ± 14 years. 72 patients (21%) had neuropsychiatric symptoms of an inflammatory origin. Fatigue was present in 78% of all patients and extreme fatigue was present in 50% of patients with an inflammatory phenotype vs 46% in the non-inflammatory phenotype. Fatigue was similar in patients with an inflammatory phenotype compared to patients with a non-inflammatory phenotype on the SF-36 VT (β: 0.8 (95% CI −4.8; 6.1) and there was less fatigue in patients with an inflammatory phenotype on the MFI and VAS (β: −3.7 (95% CI: −6.9; −0.5) and β: −1.0 (95% CI −1.6; −0.3)). There was no association between disease activity and fatigue, but symptoms of anxiety and depression (HADS) associated strongly with all fatigue measurements. Conclusion This study suggests that intervention strategies to target fatigue in (NP)SLE patients may need to focus on symptoms of anxiety and depression rather than immunosuppressive treatment.

Symptomatic osteonecrosis of the hip and knee in patients with systemic lupus erythematosus: Prevalence, pattern, and comparison of natural course

Lupus ◽  
2021 ◽  
pp. 096120332110310
Author(s):  
Mehmet Ersin ◽  
Mehmet Demirel ◽  
Mehmet Ekinci ◽  
Lezgin Mert ◽  
Çiğdem Çetin ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Bone Structure ◽  
Survival Rates ◽  
Knee Joints ◽  
Joint Involvement ◽  
Systemic Lupus ◽  
Kaplan Meier ◽  
The Mean

Objective Osteonecrosis (ON), also known as avascular necrosis, is characterized by the collapse of the architectural bone structure secondary to the death of the bone marrow and trabecular bone. Osteonecrosis may accompany many conditions, especially rheumatic diseases. Among rheumatic diseases, osteonecrosis is most commonly associated with systemic lupus erythematosus (SLE). We assessed prevalence and distribution pattern of symptomatic ON in patients with SLE and compare the natural courses of hip and knee ON. Methods 912 SLE patients admitted between 1981 and 2012 were reviewed. SLE patients with symptomatic ON were retrospectively identified both from the existing SLE/APS database. The prevalence of symptomatic ON was calculated; with ON, the joint involvement pattern was determined by examining the distribution of the joints involved, and then the data about the hip and knee joints were entered in the Kaplan-Meier analysis. Kaplan-Meier methods were used to calculate 5- and 10-year rates of ON-related hip (the hip group) and knee survival (the knee group). Results Symptomatic ON developed in various joints in 97 of 912 patients with SLE, and the overall prevalence of ON was detected as 10.6%. The mean age at the time of SLE and ON diagnoses were 27.9 ± 9.9 (14–53) and 34.2 ± 11.3 (16–62) years, respectively. The mean duration from diagnosis of SLE to the first development of ON was 70.7± 60.2 (range = 0–216) months. The most common site for symptomatic ON was the hips (68%, n=66), followed by the knees (38%, n = 37). According to Kaplan-Meier analysis, hip and knee joint survival rates associated with 5-year ON were 51% and 88%, and 10-year survival rates were 43% and 84%, respectively. Conclusion We observed that the prevalence of symptomatic ON in patients with SLE was 10.6%. With the estimated 10-year survival rates of 40% versus 84% for the hip and knee joints, respectively, hip involvement may demonstrate a more aggressive course to end-stage osteoarthritis than the knee involvement.

scholarly journals The impact of symptoms on quality of life before and after diagnosis of coeliac disease: the results from a Polish population survey and comparison with the results from the United Kingdom

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Emilia Majsiak ◽  
Magdalena Choina ◽  
Dominik Golicki ◽  
Alastair M. Gray ◽  
Bożena Cukrowska
Keyword(s):  
Quality Of Life ◽  
United Kingdom ◽  
Coeliac Disease ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
The United Kingdom ◽  
Before And After ◽  
The Mean ◽  
The Uk

Abstract Background Coeliac disease (CD) is characterised by diverse clinical symptoms, which may cause diagnostic problems and reduce the patients’ quality of life. A study conducted in the United Kingdom (UK) revealed that the mean time between the onset of coeliac symptoms and being diagnosed was above 13 years. This study aimed to analyse the diagnostic process of CD in Poland and evaluate the quality of life of patients before and after CD diagnosis. In addition, results were compared to the results of the original study conducted in the UK. Methods The study included 2500 members of the Polish Coeliac Society. The patients were asked to complete a questionnaire containing questions on socio-demographic factors, clinical aspects and quality of life, using the EQ-5D questionnaire. Questionnaires received from 796 respondents were included in the final analysis. Results The most common symptoms reported by respondents were bloating (75%), abdominal pain (72%), chronic fatigue (63%) and anaemia (58%). Anaemia was the most persistent symptom, with mean duration prior to CD diagnosis of 9.2 years, whereas diarrhoea was observed for the shortest period (4.7 years). The mean duration of any symptom before CD diagnosis was 7.3 years, compared to 13.2 years in the UK. CD diagnosis and the introduction of a gluten-free diet substantially improved the quality of life in each of the five EQ-5D-5L health dimensions: pain and discomfort, anxiety and depression, usual activities, self-care and mobility (p < 0.001), the EQ-Index by 0.149 (SD 0.23) and the EQ-VAS by 30.4 (SD 28.3) points. Conclusions Duration of symptoms prior to the diagnosis of CD in Poland, although shorter than in the UK, was long with an average of 7.3 years from first CD symptoms. Faster CD diagnosis after the onset of symptoms in Polish respondents may be related to a higher percentage of children in the Polish sample. Introduction of a gluten-free diet improves coeliac patients’ quality of life. These results suggest that doctors should be made more aware of CD and its symptoms across all age groups.

Hospitalization in patients with systemic lupus erythematosus at Tawam Hospital, United Arab Emirates (UAE): Rates, causes, and factors associated with length of stay

Lupus ◽  
2021 ◽  
pp. 096120332199008
Author(s):  
Reem Aldarmaki ◽  
Hiba I Al Khogali ◽  
Ali M Al Dhanhani
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Length Of Stay ◽  
Lupus Nephritis ◽  
United Arab Emirates ◽  
Lupus Erythematosus ◽  
Hospitalization Rate ◽  
Systemic Lupus ◽  
Factors Associated ◽  
Icu Admission ◽  
The Mean

Introduction Systemic lupus erythematosus (SLE) is a relapsing and remitting multiorgan disease associated with significant morbidity and mortality. The survival rate of patients with SLE has recently improved, which was associated with increased morbidity and hospitalization rates. Therefore, this study aimed to examine the rate and causes of hospitalization in patients with SLE and explore factors associated with increased length of stay (LOS). Methods Patients who visited rheumatology clinics (Tawam hospital, United Arab Emirates (UAE)) and fulfilled the American College of Rheumatology (ACR) SLE criteria were identified. Retrospective charts were reviewed to determine previous admissions. Demographic data, reason for hospitalization, duration of hospitalization, intensive care unit (ICU) admission, number of specialist consultations, medications used, and SLE characteristics at time of admission were collected. The hospitalization rate was calculated as the number of hospitalized patients divided by the total number of patients with the disease. We performed multivariable regression analysis for factors associated with increased LOS. Results A total of 91 patients with SLE (88 women and 3 men) met the inclusion criteria with a mean disease duration of 10.2 years (SD 5.5). A total of 222 admissions were identified, and 66 of 91 patients were admitted at least once. The mean crude hospitalization rate calculated was 29.8%. The primary reason for admission was pregnancy (29%), SLE activity (24%), and infection (20%). When combining primary and secondary reasons, the proportion of admissions due to SLE activity increased to 32%. The mean LOS was 5.9 (SD 6.0) days. About 7% of admitted patients required ICU admission. In multivariable analysis, patients with lupus nephritis, complications during hospitalization, and increased number of specialists consultations and who were admitted to ICU and started new medication were all associated with increased LOS. Conclusion A significant proportion of patients with SLE were hospitalized during their disease course. The hospitalization rate in this study appears to be higher than those reported elsewhere. Disease flare is the leading cause of admission in patients with SLE in this relatively young cohort. Lupus nephritis has been found to be significantly related to longer LOS. Measurements taken to reduce the incidence and severity of flares would likely decrease hospitalization rate and LOS in patients with SLE.

Sign in / Sign up

Export Citation Format

Share Document