Impact of disease activity on organ damage progression in systemic lupus erythematosus: University of Toronto Lupus Clinic Cohort.

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To examine the role of disease activity on organ damage over 5 years in patients with active systemic lupus erythematosus (SLE) despite standard of care.This analysis of the University of Toronto Lupus Clinic cohort assessed organ damage (measured by Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]) in patients with active SLE (SLE Disease Activity Index- 2000 [SLEDAI-2K] ≥6), using Cox proportional time-independent hazard models. Subgroup analyses were conducted in patients with SLEDAI-2K 6 or 7, 8 or 9, and ≥10 at baseline, and in the overall study population by steroid dose at study entry (<7.5 vs ≥7.5 mg/day).Among the overall study population (N=649), SDI progression was observed in 209 (32.2%) patients over the 5-year follow-up. Mean SDI change in patients with a score >0 was generally consistent across all SLEDAI-2K subgroups. Multivariable analyses identified age at study start (hazard ratio [HR] 1.03, p<0.0001), steroid dose (HR 2.03, p<0.0001), immunosuppressants (HR 1.44, p=0.021), and SLEDAI-2K (subgroup analyses HR 1.64─2.03, p=0.0017─<0.0001) as the greatest risk factors for SDI progression, while a study start date after the year 2000 had a protective effect on SDI progression compared with a start date prior to the year 2000 (HR 0.65, p=0.0004).Patients within the higher SLEDAI-2K subgroups at study entry, or receiving high doses of steroids, were more likely to have organ damage progression.


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