Background Today, systemic lupus erythematodes (SLE) is a chronic disease with high survival rates, manageable in the majority of cases with immunosuppressive therapy.
Objectives The aim of the study was to evaluate whether treatment regimens have changed in the last decade and if clinical features of the disease as well as patient-reported outcomes have improved.
Methods Between 1993 and 2012, on average 1,166 patients with SLE were recorded annually in the National Database of the German Collaborative Arthritis Centres. Within this sample, we analysed two cohorts of patients who were enrolled in 1994-1998 (1st cohort, n=467) or 2004-2008 (2nd cohort, n=376) and followed for at least five years each. Differences in immunosuppressive treatment, disease activity (physician assessment on a numerical rating scale 0-10), global health and pain (patient assessment 0-10) were compared between the two cohorts. Cross-sectional data of all SLE patients were analysed to verify whether the two cohorts were representative of the entire database.
Results The use of immunosuppressive therapy was more frequent in the 2nd cohort (see table). In particular, treatments with antimalarials and combinations of immunosuppressive drugs have increased significantly (p<0.001). In both cohorts, around 70% of patients needed continuous glucocorticoid (GC) treatment, and almost 10% remained on dosages >7.5mg during follow up. One third of the patients were taking pain medication continuously during follow-up in both cohorts. The percentage of patients with a moderate or high disease activity (4-10) decreased significantly in the 2nd cohort (p<0.01). In both cohorts, around 40% of all patients reported ongoing moderate or high levels of pain and impaired global health scores (4-10), respectively.
Conclusions Comparing the two cohorts, immunosuppressive treatment regimens were intensified in the 2000s and a higher percentage of SLE patients achieved a low disease activity as assessed by the physicians. Nevertheless, the long term use of GCs and pain medication as well as the impaired patient reported pain and global health assessments reflect the need to further focus on these aspects in treatment strategies.
Disclosure of Interest K. Albrecht Grant/research support: The database was funded by the German Federal Minister of Research from 1999 to 2007 (grant #01 GI 0344/3). Since 2007, the Working Group of the regional corporate arthritis centers and a consortium of pharmaceutical companies has been funding the National Database by an unconditional grant to the German Rheumatological Society., D. Huscher: None declared, S. Bischoff: None declared, K. Thiele: None declared, M. Backhaus: None declared, J. Richter: None declared, I. Kötter: None declared, A. Zink: None declared
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