Anti-phospholipid antibodies do not predict damage in SLE patients in the 21st century—an observational study from the Lupus-Cruces cohort

Abstract

OBJECTIVE To compare the influence of antiphospholipid antibodies (aPL) on global and cardiovascular damage in patients with systemic lupus erythematosus (SLE) diagnosed before and after year 2000. METHODS 286 patients from the Lupus-Cruces cohort with a minimum follow-up of 5 years, divided into two sub-cohorts according to the date of diagnosis, before 2000 (<2000) and from 2000 on (≥2000). We compared the mean SDI score and global and cardiovascular damage-free survival rates in the presence/absence of aPL in both sub-cohorts. Variables potentially modulating damage among aPL-positive patients were analysed. RESULTS The sub-cohorts were comparable for demographic and lupus-related variables except for treatment variables: the ≥2000 sub-cohort received lower doses of prednisone and more hydroxychloroquine, low-dose aspirin, statins, immunosuppressive agents and Vitamin D. aPL-positive patients in the <2000, but not in the ≥2000 sub-cohort, accrued more damage compared with aPL-negative. In the <2000 sub-cohort, the adjusted HRs for global and cardiovascular damage in aPL-positive vs. aPL-negative patients were 1.98 (95% CI 1.24-3.14) and 9.3 (95% CI 3.24-26.92), respectively. No differences in damage were seen between aPL-positive and aPL-negative patients in the ≥2000 sub-cohort. Hypertension (HR 4.64, 95%CI 1.33-16.19), lupus anticoagulant (HR 3.85, 95%CI 1.1-13.41) and the number of months on hydroxychloroquine (HR 0.97, 95%CI 0.95-0.99) were independent predictors of vascular damage in the combined analysis of all aPL-positive patients. CONCLUSION The effects of aPL on damage accrual in SLE patients have been reduced over the last years. The widespread use of hydroxychloroquine and a better thromboprophylaxis are likely causing this change.

Generic and disease-adapted cardiovascular risk scores as predictors of atherosclerosis progression in SLE

“…The persistent use (at least 75% and 100% of follow-up time) of antiplatelets, statins, antihypertensives and hydroxychloroquine (HCQ) during the 3-year follow-up period was included in the univariate analysis, but no statistical significance was demonstrated for any of these treatments (online supplemental table 2). HCQ has been shown to prevent thrombotic cardiovascular events in several retrospective and prospective studies in SLE, and especially its long duration 13 47 48. In our study, HCQ use was not found to have a protective role against subclinical atherosclerosis progression.…”

Systemic lupus erythematosus and cardiovascular disease

“…Further, thrombogenic microparticles have been reported to be induced by aPL [ 75 ]. Another aspect of this type of aPL effect is complement activation, which may promote thrombosis though mechanisms need to be elucidated more [ 76 , 77 , 78 ].…”

“…Even though aPL and APS remain an important cause of CVD including thrombosis in SLE, recent studies indicate that improved treatment, with hydroxychloroquine, life‐long anticoagulant treatment, statins, and optimization of prednisolone treatment, has considerably improved prognosis and thus other causes of CVD in SLE become relatively more important [ 78 ].…”