SLICC PI: DR. JOHN G. HANLY

Clinical outcomes and quality of life in lupus nephritis

Studies in a prospective, international, inception cohort study Funding Source: Bristol-Myers Squibb

The objective of this study is to develop models for lupus nephritis (LN) based on the analysis of longitudinal data from the Systemic Lupus International Collaborating Clinics (SLICC) international inception cohort database, with respect to: Progression to renal impairment and end-stage renal disease (ESRD), quality of life (QOL) in SLE patients with and without LN and evolution of other lupus disease features such as damage accrual and development of co-morbidities. Is subsequent studies these models will be used to inform an economic evaluation of LN, where the long-term impact of interventions on cost and benefits are projected.

Up to July 2017, two publications have emanated from this effort. In the first one, LN occurrence was found in 38% of patients, and in most cases, this happened at disease presentation. Patients with LN were younger, more frequently men and of African descent than those without LN. Despite treatment, patients with LN were at increased risk of developing ESRD and of experiencing early mortality. Renal impairment was associated with diminished health-related QOL. Analyses using multistate modeling for proteinuria and glomerular filtration rate allowed for the identification of improvement and deterioration on these end-points and the risk factors that predispose to them.

Using state modeling the cost of LN is now being examined; it is hoped that new therapeutic interventions will lead to better outcomes and, consequently, to diminish the cost of this pervasive SLE manifestation.


References:

  • 1. Hanly JG, Su L, Urowitz MB, Romero-Diaz J, Gordon C, Bae SC, Bernatsky S, Clarke AE, Wallace DJ, Merrill JT, Isenberg D A, Rahman A, Ginzler EM, Petri M, Bruce IN, Dooley MA, Fortin P, Gladman DD, Sanchez-Guerrero J, Steinsson K, Ramsey-Goldman R, Khamashta MA, Aranow C, Alarcón GS, Fessler BJ, Manzi S, Nived O, Sturfelt GK, Zoma AA, van Vollenhoven RF, Ramos-Casals M, Ruiz-Irastorza G, Lim SS, Kalunian KC, Inanc M, Kamen DL, Peschken CA, Jacobsen S, Askanase A, Theriault C and Farewell V. A Longitudinal Analysis of Outcomes of Lupus Nephritis in an International Inception Cohort Using a Multistate Model Approach. Arthritis Rheumatol. 2016 Aug;68(8):1932-44. doi: 10.1002/art.39674. PMID: 26991067
  • 2.Hanly JG, O’Keeffe AG, Su L, Urowitz MB, Romero-Diaz J, Gordon C, Bae SC, Bernatsky S, Clarke AE, Wallace DJ, Merrill JT, Isenberg DA, Rahman A, Ginzler EM, Fortin P, Gladman DD, Sanchez-Guerrero J, Petri M, Bruce IN, Dooley MA, Ramsey-Goldman R, Aranow C, Alarcón GS, Fessler BJ, Steinsson K, Nived O, Sturfelt GK, Manzi S, Khamashta MA, van Vollenhoven RF, Zoma AA, Ramos-Casals M, Ruiz-Irastorza G, Lim SS, Stoll T, Inanc M, Kalunian KC, Kamen DL, Maddison P, Peschken CA, Jacobsen S, Askanase A, Theriault C, Thompson K, Farewell V. The frequency and outcome of lupus nephritis: results from an international inception cohort study. Rheumatology (Oxford). 2016 Feb;55(2):252-62. doi: 2634222210.1093/rheumatology/kev311. PMID: 26342222

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