SLE AT THE TURN OF THE THIRD MILLENNIUM: HOW DISEASE MANAGEMENT HAS CHANGED IN CLINICAL PRACTICE

Background/Purpose With the new millennium major changes have occurred in the management of lupus, these encompass the optimization of the use of old drugs, the identification of therapeutic targets such as LLDAS and remission and the introduction of new drugs such as biologics. The aim of the present study was to analyze how the new treatment paradigm impacted on the management of SLE over time in the real-life setting. Methods This is a retrospective observational study on SLE patients regularly followed at our unit and with a follow-up of at least 1 year; patients were divided in 2 groups: group 1 including patients diagnosed between 1980 and 2000 and group 2 those diagnosed after 2000. Demographic characteristics, clinical manifestations at disease onset and cumulative organ involvement, disease activity, organ damage and disease state over time and treatments received were compared. Results 428 SLE patients were included in the study, 377 females (88%), 143 patients in Group 1 (33.4%) and 285 (66.6%) in group 2. Presenting symptoms were similar between the 2 groups, while over the entire disease course we found a higher frequency of renal involvement (54% vs 40%) and neuropsychiatric involvement (17% vs 6%) in patients diagnosed before 2000. As far as therapy is concerned, almost all patients received GC during their disease course although in group 2 we found 11 patients who did never take GC (4%, p=0.02). Longitudinal analysis of the GC cumulative dose showed similar doses during the first year of the disease; however, at 5 and 10 years after diagnosis group 1 received significantly higher dosages (median 8.7 g vs 7.6 g and 15.35 g vs 14 g respectively, p<0.001 in both analyses). Interestingly, a higher percentage of patients was GC-free at 5 years from diagnosis in the group diagnosed after 2000 (29.4% vs 6.6%). 394 patients received HCQ during the disease course (93.5%), a higher proportion of patients in group 2 although not statistically different (95% vs 90%). The proportion of patients who received at least 1 IS drug within the first year of follow-up was significantly higher in patients diagnosed after 2000 (60.7% vs 39%, p<0.001) Overall, 129 patients received at least on biological drug (30%), with a significantly higher proportion in group 2 (34% vs 22%, p=0.01). In group 2, 22 (8%) patients received a biological treatment within the first year since diagnosis. At 1 year from diagnosis remission resulted more frequently achieved in patients diagnosed after 2000 (57% vs 46% respectively, p=0.03). Overall 9.7% of patients developed at least 1 item of the SLICC/DI within the first year from diagnosis (median SDI=1, range 1-3); 17.7% within 5 years (median SDI= 1, range 1-5) and 32.6% within 10 years (median SDI=1, range 1-6). The median damage score over time was similarly very low in both groups. The occurrence of renal damage (RD), cardiovascular events (CVE) and osteoporotic fractures did not show statistically significant differences between the 2 groups. Conclusions The study highlights how the clinical management of SLE patients has changed in recent years by incorporating the new treatment paradigm based on the early use of immunosuppressive drugs and steroid-sparing strategies, resulting in more effective disease control.