Contribution of abnormal BMI to adverse health-related quality of life outcomes after a 52-week therapy in patients with SLE

Borg, Alexander; Gomez, Alvaro; Cederlund, Arvid; Cobar, Flordelyn; Qiu, Victor; Lindblom, Julius; Emamikia, Sharzad; Enman, Yvonne; Pettersson, Susanne; Parodis, Ioannis

doi:10.1093/rheumatology/keaa909

Cited by 14 publications

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“…Herein, we investigated frequencies of adverse HRQoL outcome and contributing factors in 760 patients with SLE who showed adequate clinical response to a 52-week long intervention with standard therapy along with belimumab or placebo, using previously reported definitions (30). We observed clinically important diminutions of patient-reported HRQoL in multiple physical, mental and social aspects compared with the general population, and high frequencies of adverse HRQoL outcomes, especially within physical domains of SF-36 and FACIT-F.…”

Section: Discussionmentioning

confidence: 97%

Adverse Health-Related Quality of Life Outcome Despite Adequate Clinical Response to Treatment in Systemic Lupus Erythematosus

et al. 2021

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Objective: To determine the prevalence of adverse health-related quality of life (HRQoL) outcomes in patients with SLE who achieved an adequate clinical response after a 52-week long standard therapy plus belimumab or placebo, and identify contributing factors.Methods: We included patients who met the primary endpoint of the BLISS-52 (NCT00424476) and BLISS-76 (NCT00410384) trials, i.e., SLE Responder Index 4 (total population: N = 760/1,684; placebo: N = 217/562; belimumab 1 mg/kg: N = 258/559; belimumab 10 mg/kg: N = 285/563). Adverse HRQoL outcomes were defined as SF-36 scale scores ≤ the 5th percentile derived from age- and sex-matched population-based norms, and FACIT-Fatigue scores <30. We investigated factors associated with adverse HRQoL outcomes using logistic regression analysis.Results: We found clinically important diminutions of HRQoL in SLE patients compared with matched norms and high frequencies of adverse HRQoL outcomes, the highest in SF-36 general health (29.1%), followed by FACIT-Fatigue (25.8%) and SF-36 physical functioning (25.4%). Overall, frequencies were higher with increasing age. Black/African American and White/Caucasian patients reported higher frequencies than Asians and Indigenous Americans, while Hispanics experienced adverse HRQoL outcome less frequently than non-Hispanics. Established organ damage was associated with adverse physical but not mental HRQoL outcomes; particularly, damage in the cardiovascular (OR: 2.12; 95% CI: 1.07–4.21; P = 0.032) and musculoskeletal (OR: 1.41; 95% CI: 1.01–1.96; P = 0.041) domains was associated with adverse SF-36 physical component summary. Disease activity showed no impact on HRQoL outcomes. In multivariable logistic regression analysis, addition of belimumab to standard therapy was associated with lower frequencies of adverse SF-36 physical functioning (OR: 0.59; 95% CI: 0.39–0.91; P = 0.016) and FACIT-F (OR: 0.53; 95% CI: 0.34–0.81; P = 0.004).Conclusions: Despite adequate clinical response to standard therapy plus belimumab or placebo, a substantial proportion of SLE patients still reported adverse HRQoL outcomes. While no impact was documented for disease activity, established organ damage contributed to adverse outcome within physical HRQoL aspects and add-on belimumab was shown to be protective against adverse physical functioning and severe fatigue.

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Section: Discussionmentioning

confidence: 97%

Adverse Health-Related Quality of Life Outcome Despite Adequate Clinical Response to Treatment in Systemic Lupus Erythematosus

et al. 2021

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“…For example, an estimate of 0.5 means that five consecutive visits in LLDAS are required to reach a 2.5 difference in the median PCS or MCS, while an estimate of 0.1 would require 25 visits. All models were adjusted for age, sex, ethnicity, country, belimumab treatment, antimalarial treatment, immunosuppressive agents, disease duration, BMI, and organ damage (SDI score), all considered factors with confounding potentiality based on previous research [ 3 , 35 , 36 ] ( Supplementary Table S2 , available at Rheumatology online). We also tested for the interaction term between belimumab use and remission/LLDAS; as no significant interaction was noted other than in one single model (exposure: remission; outcome: SF-36 PCS), the term was excluded from the final models.…”

Section: Methodsmentioning

confidence: 99%

Impact of remission and low disease activity on health-related quality of life in patients with systemic lupus erythematosus

et al. 2022

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Objectives To investigate the impact of remission and lupus low disease activity state (LLDAS) on health-related quality of life (HRQoL) in systemic lupus erythematosus. Methods SF-36, EQ-5D-3L and FACIT-Fatigue data from the BLISS-52 (NCT00424476) and BLISS-76 (NCT00410384) trials were used. Duration in remission/LLDAS required to reach a HRQoL benefit ≥ minimal clinically important differences (MCIDs) during and post-treatment was determined using quantile regression and generalised estimating equations. Results Patients (N = 1684) were assessed every 4th week (15 visits). Four cumulative (β = 0.60) or four consecutive (β = 0.66) visits in remission were required to achieve a benefit ≥MCID in SF-36 physical component summary (PCS) scores, and six cumulative (β = 0.44) or five consecutive (β = 0.49) for a benefit ≥MCID in mental component summary (MCS) scores. Eight cumulative (β = 0.30 for both) or eight consecutive (β = 0.32 for both) visits in LLDAS were required for a benefit in PCS/MCS ≥MCID, respectively. For EQ-5D-3L index scores ≥MCID, six cumulative (β = 0.007) or five consecutive (β = 0.008) visits in remission were required, and eight cumulative (β = 0.005) or six consecutive (β = 0.006) visits in LLDAS. For FACIT-Fatigue scores ≥MCID, 12 cumulative (β = 0.34) or 10 consecutive (β = 0.39) visits in remission were required, and 17 cumulative (β = 0.24) or 16 consecutive (β = 0.25) visits in LLDAS. Conclusion Remission and LLDAS contribute to a HRQoL benefit in a time-dependent manner. Shorter time in remission than in LLDAS was required for a clinically important benefit in HRQoL, and longer time in remission for a benefit in mental compared with physical HRQoL aspects. When remission/LLDAS was sustained, the same benefit was achieved in a shorter time.

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“…In general, when evaluating the impact of the health problems studied in SLE patients, there was a lack of consideration and adjustment for socioeconomic factors [ 28 ]. Socioeconomic data are often easy to obtain, but researchers should be aware of their importance as they may modify the impact of obesity, diabetes mellitus, and cardiovascular risk in underserved SLE patient populations.…”

Section: Discussionmentioning

confidence: 99%

“…Our results revealed that there are certain measures of burden that have been poorly evaluated in recent literature, such as the burden of treatment, disability, health care utilization, work participation, and, clearly, economic burden [ 13 , 28 ]. Most studies to date that have attempted to assess the impact of obesity and diabetes on the health outcomes of SLE patients have a cross-sectional design, so causality cannot be inferred [ 15 , 19 , 29 , 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

Obesity, Diabetes, and Cardiovascular Risk Burden in Systemic Lupus Erythematosus: Current Approaches and Knowledge Gaps—A Rapid Scoping Review

Hernández-Negrín

Ricci

Mancebo-Sevilla

et al. 2022

IJERPH

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Obesity, diabetes mellitus, and cardiovascular risk are real challenges in systemic lupus erythematosus (SLE) clinical practice and research. The evidence of the burden of these health problems in SLE patients is determined by the methods used to assess them. Therefore, the aim of this scoping review is to map current approaches in assessing obesity, diabetes mellitus, and cardiovascular risk burden in SLE patients and to identify existing knowledge gaps in this field. This rapid scoping review was conducted according to the Joanna Briggs Institute methodology and identified 274 articles, of which 73 were included. Most studies were conducted at European institutions and patients were recruited from specialist hospital clinics, the majority of whom were women. The burden of obesity and diabetes mellitus for SLE patients was assessed mainly in terms of prevalence, impact on disease activity, and cardiometabolic risk. The burden of cardiovascular risk was assessed using multiple approaches, mainly imaging and laboratory methods, and risk factor-based scores, although there is great heterogeneity and uncertainty between the methods used. This review highlights the importance of improving and standardizing the approach to obesity, diabetes, and cardiovascular risk in SLE patients through a holistic assessment that includes lifestyle, clinical, biological, and social aspects.

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Contribution of abnormal BMI to adverse health-related quality of life outcomes after a 52-week therapy in patients with SLE

Cited by 14 publications

References 38 publications

Adverse Health-Related Quality of Life Outcome Despite Adequate Clinical Response to Treatment in Systemic Lupus Erythematosus

Adverse Health-Related Quality of Life Outcome Despite Adequate Clinical Response to Treatment in Systemic Lupus Erythematosus

Impact of remission and low disease activity on health-related quality of life in patients with systemic lupus erythematosus

Obesity, Diabetes, and Cardiovascular Risk Burden in Systemic Lupus Erythematosus: Current Approaches and Knowledge Gaps—A Rapid Scoping Review

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