RESEARCH - Changing patterns in morality and disease outcomes for patients with SLE

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J Rheumatol. 2008 Sep 15.

Changing Patterns in Mortality and Disease Outcomes for Patients with

Systemic Lupus Erythematosus.

Urowitz MB, Gladman DD, Tom BD, Ibañez D, Farewell VT.

From the Toronto Western Hospital, Centre for Prognosis Studies in

Rheumatic Diseases, Toronto Western Hospital, University Health

Network, Toronto, Canada; and the Biostatistics Unit, Institute of

Public Health, Medical Research Council, Cambridge, UK.

OBJECTIVE: Survival of patients with systemic lupus erythematosus

(SLE) has improved significantly, but new morbidities have emerged,

leading to altered patterns of outcome in this disease. We examined

changes in mortality and other outcomes over time in a large SLE

cohort.

METHODS: A group of 1241 patients from the University of Toronto Lupus

Clinic followed prospectively were divided into 4 entry cohorts - 1:

1970-1978, 2: 1979-1987, 3: 1988-1996, 4: 1997-2005. These cohorts

were followed through four 9-year calendar periods defined over the

same intervals. Both cohort and calendar effects were assessed for the

following outcomes: mortality (standardized mortality ratio; SMR),

disease activity over time (adjusted mean SLEDAI; AMS), cumulative

damage (Systemic Lupus International Collaborating Clinics Damage

Index; SDI), coronary artery disease (CAD), and osteonecrosis (ON).

regression models were used to further investigate mortality and

the influence on it of the disease-related factors.

RESULTS:Over the 36-year period of the study, 211 deaths occurred. The

overall SMR in the first and last decades were 12.60 (95% CI: 9.13,

17.39) and 3.46 (95% CI: 2.71, 4.40) respectively. When SMR were

stratified by the entry cohort and calendar period, there is evidence

of a calendar-period effect but no cohort effect. The AMS decreased

over the decades, while SDI, CAD, and ON increased. There were

significant detrimental effects for male sex, CAD, AMS, SDI, and use

of immunosuppressive drugs and significant protective effects for use

of antimalarials and the effect of calendar period on mortality.

CONCLUSION: Our study demonstrates improved survival in patients with

SLE over a 36-year period. Disease-related variables included in the

model are important factors for mortality in this SLE cohort, but

could not completely explain the trend of improved survival over

calendar period observed.

PMID: 18793004

http://www.ncbi.nlm.nih.gov/pubmed/18793004

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