Mortality in SLE

Bernatsky, Sasha; Levy, Deborah; Ramsey‐Goldman, Rosalind; Gordon, Caroline; Rahman, Anisur; Clarke, Ann E.

doi:10.1016/b978-1-4377-1893-5.00057-1

Cited by 5 publications

(4 citation statements)

References 80 publications

(61 reference statements)

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“…Morbidity and mortality have improved considerably for patients with systemic lupus erythematosus (SLE) in the past 50 years; the 4-year survival rate of 50% in 1950 is now a 10-year survival rate of 90%. 1 However, some patients continue to die prematurely, suffer significant damage and have a reduced quality of life. 1 A recent study 2 of patients with lupus nephritis in a lupus cohort followed for 30 years found no change in the risk of the development of end-stage disease over this time and only a marginal improvement in mortality.…”

Section: Introductionmentioning

confidence: 99%

“… 1 However, some patients continue to die prematurely, suffer significant damage and have a reduced quality of life. 1 A recent study 2 of patients with lupus nephritis in a lupus cohort followed for 30 years found no change in the risk of the development of end-stage disease over this time and only a marginal improvement in mortality. The authors suggested that these results indicate that the benefits of conventional therapies (meaning steroids and immunosuppressives) have been maximised.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of atacicept for prevention of flares in patients with moderate-to-severe systemic lupus erythematosus (SLE): 52-week data (APRIL-SLE randomised trial)

et al. 2014

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ObjectivesDespite advances in systemic lupus erythematosus (SLE) treatment, many patients suffer from the disease and side effects. Atacicept is a fusion protein that blocks B-lymphocyte stimulator and a proliferation-inducing ligand, which are increased in patients with SLE.MethodsIn this double-blind, placebo-controlled study, patients with moderate-to-severe SLE were randomised to atacicept 75 mg or atacicept 150 mg administered subcutaneously, or placebo twice-weekly for 4 weeks, then weekly for 48 weeks. Primary and secondary efficacy measures were the proportion of patients experiencing at least one flare of British Isles Lupus Assessment Group A or B, and time to first flare, respectively.ResultsEnrolment in the atacicept 150 mg arm was discontinued prematurely due to two deaths. In the intention-to-treat population (n=461), there was no difference in flare rates or time to first flare between atacicept 75 mg and placebo. Analysis of patients treated with atacicept 150 mg suggested beneficial effect versus placebo in flare rates (OR: 0.48, p=0.002) and time to first flare (HR: 0.56, p=0.009). Both atacicept doses were associated with reductions in total Ig levels and anti-dsDNA antibodies, and increases in C3 and C4 levels. Most treatment-emergent adverse events were mild or moderate.ConclusionsThere was no difference between atacicept 75 mg and placebo for flare rate or time to first flare. Analysis of atacicept 150 mg suggested benefit.Trial registration numberEudraCT: 2007-003698-13; NCT00624338.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of atacicept for prevention of flares in patients with moderate-to-severe systemic lupus erythematosus (SLE): 52-week data (APRIL-SLE randomised trial)

et al. 2014

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“…[4][5][6][7] The BLISS trials excluded patients with acute lupus nephritis, and the effect of belimumab therapy on renal abnormalities was not a prespecified endpoint of these studies. 2,3 This post-hoc pooled analysis was, however, conducted to derive information about the potential effect of belimumab on renal parameters and in patients who were receiving MMF therapy at baseline.…”

Section: Discussionmentioning

confidence: 99%

“…Renal involvement occurs in 40%-70% of all patients with SLE, with endstage renal disease developing in 10%-20% of all patients. [4][5][6][7] Recently, the American College of Rheumatology published guidelines on the screening, treatment, and management of lupus nephritis, summarizing induction and maintenance therapy approaches from severe active to quiescent renal disease. 8 The BLISS trials were not designed to specifically assess the effects of belimumab on renal parameters.…”

Section: Introductionmentioning

confidence: 99%

Effect of belimumab treatment on renal outcomes: results from the phase 3 belimumab clinical trials in patients with SLE

Dooley

Houssiau

Aranow

et al. 2012

Lupus

251

139

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A pooled post-hoc analysis of the phase 3, randomized, placebo-controlled BLISS trials (1684 patients with active systemic lupus erythematosus (SLE)) was performed to evaluate the effect of belimumab on renal parameters in patients with renal involvement at baseline, and to explore whether belimumab offered additional renal benefit to patients receiving mycophenolate mofetil at baseline. In addition to belimumab or placebo, all patients received standard SLE therapy. Patients with severe active lupus nephritis were excluded from the trials. Over 52 weeks, rates of renal flare, renal remission, renal organ disease improvement (assessed by Safety of Estrogens in Lupus Erythematosus National Assessment–Systemic Lupus Erythematosus Disease Activity Index and British Isles Lupus Assessment Group), proteinuria reduction, grade 3/4 proteinuria, and serologic activity favored belimumab, although the between-group differences in most renal outcomes were not significant. Among the 267 patients with renal involvement at baseline, those receiving mycophenolate mofetil or with serologic activity at baseline had greater renal organ disease improvement with belimumab than with placebo. Limitations of this analysis included the small patient numbers and the post-hoc nature of this pooled analysis. The results suggest that belimumab may offer renal benefit in patients with SLE. Further study is warranted in patients with severe active lupus nephritis.

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Lupus Erythematosus

Goodfield,

Dutz,

McCourt

2016

Rook's Textbook of Dermatology, Ninth Edition

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Lupus erythematosus (LE) is a complex spectrum of disease, involving one or multiple organ systems, and characterized by humoral and cellular autoimmunity, resulting in combinations of skin, joint, vascular and internal organ involvement. Skin disease occurs in the overwhelming majority of patients, and the patterns of skin involvement form an important part of subclassification, with localized discoid lupus usually being a single‐system manifestation, and acute cutaneous LE part of a potentially fatal multisystem disease. Intermediate forms, including subacute cutaneous LE are common and variable in their involvement of other organ systems. Ultraviolet exposure is an important disease precipitant. LE forms a major part of the group of disorders called connective tissue diseases, along with systemic sclerosis, localized and generalized morphoea, dermatomyositis, rheumatoid arthritis and Sjögren syndrome on the basis of clinical, pathological and immunological overlap.

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Mortality in SLE

Cited by 5 publications

References 80 publications

Efficacy and safety of atacicept for prevention of flares in patients with moderate-to-severe systemic lupus erythematosus (SLE): 52-week data (APRIL-SLE randomised trial)

Efficacy and safety of atacicept for prevention of flares in patients with moderate-to-severe systemic lupus erythematosus (SLE): 52-week data (APRIL-SLE randomised trial)

Effect of belimumab treatment on renal outcomes: results from the phase 3 belimumab clinical trials in patients with SLE

Lupus Erythematosus

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