Identifying a Response for the Systemic Lupus Erythematosus Disease Activity 2000 Glucocorticoid Index

Abstract

Objective To compare the performance of the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI‐2K) and the SLEDAI‐2K Glucocorticoids (SLEDAI‐2KG) indices in identifying responders to standard of care therapy. Methods Data from adult patients seen between 1995 and 2018 at the University of Toronto Lupus Clinic were analyzed. Patients with active disease (SLEDAI‐2K score ≥6) and receiving prednisone ≥5 mg/day, and with a follow‐up visit at 9 months, were studied. Response to standard of care therapy at first follow‐up visit was assessed using the SLEDAI‐2K and SLEDAI‐2KG. The performances of the SLEDAI‐2K and SLEDAI‐2KG were compared using a cutoff point of 4. Results In a cohort of 188, the majority of patients were female (86.0%) and White (47.9%). Of 188 patients, 145 (77.1%) were responders and had a decrease in SLEDAI‐2K score of ≥4. The SLEDAI‐2KG identified 142 (97.9%) responders among the SLEDAI‐2K responders. More importantly, the SLEDAI‐2KG identified 11 (25.6%) additional responders among SLEDAI‐2K nonresponders (n = 43). This resulted from the ability of the SLEDAI‐2KG to account for the decrease in glucocorticoids dose. Conclusion The SLEDAI‐2KG provides a novel concept for the assessment of lupus disease activity while accounting for glucocorticoids dosage to reflect on disease activity overall at a particular visit. The SLEDAI‐2KG accounts for the disease activity for each descriptor while also accounting for the current glucocorticoids dosage. The SLEDAI‐2KG adds 1 additional variable (glucocorticoids dosage) to the SLEDAI‐2K, which could alter response rates in drug trials and observational studies.

Serum amyloid A‐to‐albumin ratio as a potential biomarker to predict the activity, severity, and poor prognosis of systemic lupus erythematosus

“…The rapid, sensitive, and specific evaluation of disease activity for patients with SLE is important for both short‐term and long‐term treatment planning. 21 Previous studies showed that inflammatory factors, such as tumor necrosis factor‐α, C3, C4, erythrocyte distribution width, platelet to lymphocyte ratio, and neutrophil‐to‐lymphocyte ratio, 22 , 23 , 24 were related to the severity of SLE. These studies support that inflammatory cytokines play an important role in the pathogenesis and disease progression of SLE.…”

New possibilities of pharmacotherapy for systemic lupus erythematosus: Prospects for the use of anifrolumab (monoclonal antibodies to type I interferon receptor)

“…Поэтому одна из важных проблем ревматологии связана с разработкой подходов к «безглюкокортикоидной» терапии СКВ [90]. Не случайно возможность минимизировать дозу ГК входит в число показателей оценки эффективности терапии СКВ [91] что нашло свое отражение в создании нового индекса активности СКВ -SLEDAI-2KG (SLEDAI-2K Glucocorticoids) [92,93]. Хотя при СКВ обычно назначаются более высокие дозы ГК, чем при других иммуновоспалительных заболеваниях, у многих пациентов не удается достигнуть оптимального эффекта (ремиссия или низкая активность), что косвенно свидетельствует о резистентности к ГК [94].…”