Corticosteroid treatment plays a role in organ damage in SLE as well as other adverse outcomes.¹

While disease activity decreases, organ damage accumulates, especially damage related to corticosteroid therapy.¹

SLEDAl-2K is a disease activity index used in SLE.² Larger values indicate greater disease activity3 SDI was used to assess accumulated organ damage since the onset of SLE, resulting from either the disease process or its sequelae.⁴ GC, glucocorticoid; SDI, Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index; SLE, systemic lupus erythematosus; SLEDAl-2K, Systemic Lupus Erythematosus Disease . Activity Index 2000; SLICC, Systemic Lupus International Collaborating Clinics

Corticosteroid use is directly correlated with increasing organ damage over time⁵

Persistent Use of Glucocorticoids Can Increase Risk

GC TREATMENT BURDEN: ORGAN DAMAGE ACCRUAL WAS HIGHER IN STEROID-EXPOSED PATIENTS VERSUS STEROID-Naïve PATIENTS (specifically at 5 and 8 years)⁵

Organ Damage in Patients With SLE based on Glucocorticoid Treatment

Baseline SLEDAI-2K was 5.2±3.7 in patients classified as glucocorticoid-naïve versus 11.6±8.3 (P<0.001) in GC-exposed patients⁵
Subsequent organ damage was assessed at 3, 5, and 8 years using the SDI⁵

Organ damage accrual more than doubled over a 5-year period versus steroid-naïve patients.⁵

ACR, American College of Rheumatology; GC, glucocorticoid; SDI, Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index; SLE, systemic lupus erythematosus; SLEDAI-2K, Systemic Lupus Erythematosus Disease Activity Index 2000.

Aim: To compare the type, amount, rate, and nature of organ damage accrual mortality, and atherosclerotic comorbidities in gluco-corticosteroid naive and gluco-corticosteroid. exposed patients with SLE Methods: Inception patients from the University of Toronto Lupus Clinic who had never taken gluco- corticosteroids and had a minimum of 3 years of follow-up were compared to patients who received gluco-corticosteroids within the first 6 months of SLE diagnosis and for at least 3 years. All patients had no damage at inception.

Complete Remission Is Rare for Patients with SLE⁶

15.9%of patients with SLE maintained in complete remission while receiving treatment including GCs‡^†,‡

Based on data from Amsterdam SLE Cohort. n=l83.⁸

Based on prospective 5-year follow-up data from the Amsterdam SLE Cohort in 117 patients who experienced clinical remission on GCs. Clinical remission on GCs was defined as a maximum SLEDAI-2K of 4, with only hypocomplementemia and presence of anti-dsDNA allowed; antimalarials, immunosuppressants, and prednisone doses up to 5 mg daily or equivalent were permitted.⁸

DORIS, Definition of Remission in Systemic Lupus Erythematosus; dsDNA, double-stranded DNA; GC, glucocorticoid; ECLAM, European Consensus Lupus Activity Measurement; PGA, Physician Global Assessment; SLE, systemic lupus erythematosus; SLEDAI, Systemic Lupus Erythematosus Disease Activity Index; SLEDAI-2K, Systemic Lupus Erythematosus Disease Activity Index 2000.

Risk of organ damage relates to GC dosing

RISK OF ORGAN DAMAGE INCREASES AT GC DOSES OF ≥7.5 MG/DAY (N=2199)¹

^*In this study, doses evaluated were mean prior prednisone dose during follow-up since cohort entry. Only data for 4 individual organ systems were reported: cataracts, osteoporotic fractures, cardiovascular damage, and renal damage.¹

The organ damage risk correlates with increasing corticosteroid doses.¹

A reduction of as little as 1 mg/day in the mean prednisone dose reduces the estimated risk of future damage by 3%. ¹

A prospective, longitudinal study of the effect of prednisone use by dose on the risk of developing organ damage over time. The study used data analysed from SLE patients in the Hopkins Lupus Cohort between 1987 and 2012 (N=2265). Patients younger than 18 years of age and those with no follow-up data were excluded from the analysis, lowering the final sample size (n=2199).¹

Impact of prednisone use by dose was calculated using Cox proportional hazards models. Organ damage was measured by SDI or by components of SDI at the individual organ systems level. SELENA-SLEDAI was used to measure overall disease activity. The SELENA-SLEDAI score was included in the Cox proportional hazards model as a 2-level variable. The impact of different levels of prior exposure to prednisone on the risk of developing new organ damage at the individual organ system level was examined, and the study reported on 4 individual types of organ damage: cataracts, osteoporotic fractures, cardiovascular damage and renal damage.¹

Learn more about
disease burden in SLE

CI, confidence interval; GC, glucocorticoid; SDI, Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index; SELENA-SLEDAI, The Safety of Estrogens in Lupus Erythematosus National Assessment version of the SLE Disease Activity Index; SLE, systemic lupus erythematosus.

References:

1. Al Sawah S, Zhang X, Zhu B, et al. Effect of corticosteroid use by dose on the risk of developing organ damage over time in systemic lupus erythematosus – the Hopkins Lupus Cohort. Lupus Sci Med. 2015;2(1):e000066. 2. Urowitz MB, Gladman DD, Ibañez D, et al. Evolution of disease burden over five years in a multicenter inception systemic lupus erythematosus cohort. Arthritis Care Res (Hoboken). 2012;64(1):132-137. 3. Lai, N.-S. et al. (2021) ‘A comparison of the correlation of systemic lupus erythematosus disease activity index 2000 (SLEDAI-2K) and systemic lupus erythematosus disease activity score (SLE-Das) with health-related quality of life’, Journal of Clinical Medicine, 10(10), p. 2137. 4. Rahman, P. et al. (2001) ‘Early damage as measured by the SLICC/ACR damage index is a predictor of mortality in systemic lupus erythematosus’, Lupus, 10(2), pp. 93–96. doi:10.1191/096120301670679959. 5. Sheane BJ, Gladman DD, Su J, et al. Disease outcomes in glucocorticosteroid-naive patients with systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2017;69(2):252-256. 6. Tani C, Vagelli R, Stagnaro C, Carli L, Mosca M. Remission and low disease activity in systemic lupus erythematosus: an achievable goal even with fewer steroids? Real-life data from a monocentric cohort. Lupus Sci Med. 2018;5(1):e000234. 7. Ugarte-Gil MF, Acevedo-Vلsquez E, Alarcَn GS, et al. The number of flares patients experience impacts on damage accrual in systemic lupus erythematosus: data from a multiethnic Latin American cohort. Ann Rheum Dis. 2015;74(6):1019-1023. 8. Tsang-A-Sjoe MW, Bultink IE, Heslinga M, Voskuyl AE. Both prolonged remission and lupus low disease activity state are associated with reduced damage accrual in systemic lupus erythematosus. Rheumatology (Oxford). 2017;56(1):121-128.

Burden of Disease

Pathophysiology of Disease

Learn More

Welcome to Unlocking-lupus Egypt

ACROSS PATIENTS WITH SLE, Disease damage increases over time.

Corticosteroid treatment plays a role in organ damage in SLE as well as other adverse outcomes.1

Corticosteroid use is directly correlated with increasing organ damage over time5

GC TREATMENT BURDEN: ORGAN DAMAGE ACCRUAL WAS HIGHER IN STEROID-EXPOSED PATIENTS VERSUS STEROID-Naïve PATIENTS (specifically at 5 and 8 years)5

Study Description

Complete Remission Is Rare for Patients with SLE6