Background Systemic Lupus Erythematosus (SLE) is a complex disease with limited treatment options. Understand the extent of disease burden among key subsets of patients (such as those experiencing flares) could help devise optimal disease management strategies.
Objectives To assess the characteristics of SLE patients currently experiencing flares in Europe (EU).
Methods A multi-center retrospective medical chart review of adult (16-89 yrs) SLE patients was conducted in 1Q2014 among rheumatologists/internal medicine physicians in big-5 EU countries (5EU): UK, France (FR), Germany (DE), Italy (IT) and Spain (SP). Physicians were recruited from a geographically representative sample in each country. Approx. 5 consecutive eligible persistent active or relapse remitting SLE patients currently managed as part of usual care were identified within the study observation window. Physicians abstracted de-identified patient data on disease characteristics, lab values and treatment patterns. Patient disease status and humanistic burden was assessed by physician per clinical judgment & patient interaction. Patients experiencing a flare (per physician clinical judgment) were identified for analysis.
Results 135 SLE patients who were experiencing flares were included in the analysis (UK: 45/FR: 22/DE: 20/IT: 20/SP: 28). Mean age (yrs) was 5 EU: 40.6/UK: 44.4/FR: 39.3/DE: 36.9/IT: 41.0/SP: 37.9; % female was 5EU: 78%/UK: 87%/FR: 59%/DE: 75%/IT: 70%/SP: 86%; % full-time employment was 5EU: 33%/UK: 20%/FR: 32%/DE: 30%/IT: 50%/SP: 43%; % part-time employment was 5EU: 18%/UK: 29%/FR: 9%/DE: 10%/IT: 10%/SP: 18%; % on sick leave was 5EU: 17%/UK: 9%/FR: 23%/DE: 25%/IT: 15%/SP: 21%. Top-5 organ manifestations observed were musculoskeletal (5EU: 88%/UK: 93%/FR: 100%/DE: 65%/IT: 95%/SP: 82%), mucocutaneous (5EU: 85%/UK: 96%/FR: 91%/DE: 65%/IT: 80%/SP: 82%), haematologic (5EU: 56%/UK: 56%/FR: 41%/DE: 60%/IT: 50%/SP: 68%), renal (5EU: 33%/UK: 33%/FR: 23%/DE: 50%/IT: 45%/SP: 21%) and pulmonary (5EU: 27%/UK: 38%/FR: 5%/DE: 10%/IT: 35%/SP: 32%). Percentage of patients with low C3 (5EU: 73%/UK: 55%/FR: 62%/DE: 85%/IT: 90%/SP: 89%), low C4 (5EU: 78%/UK: 59%/FR: 90%/DE: 90%/IT: 75%/SP: 89%) and positive anti-ds-DNA (5EU: 90%/UK: 80%/FR: 100%/DE: 95%/IT: 95%/SP: 93%) were high. Among those with lab measures, mean ESR (mm/h) was 5EU: 50.1/UK: 44.4/FR: 47.6/DE: 41.2/IT: 54.6/SP: 63.8; mean hemoglobin (g/L) was 5EU: 10.4/UK: 9.8/FR: 11.1/DE: 10.5/IT: 10.5/SP: 10.7. Humanistic burden (reported via physician ratings, on a scale of 1 (most impact) to 7 (least impact)) was (mean scores): patient ability to perform every-day tasks - 5EU: 4.4/UK: 4.4/FR: 5.1/DE: 3.8/IT: 4.5/SP: 4.0; patient ability to interact fully with family and friends - 5EU: 4.9/UK: 4.9/FR: 5.5/DE: 4.2/IT: 5.0/SP: 4.9; patient ability to work/keep employment - 5EU: 3.9/UK: 4.2/FR: 4.2/DE: 2.8/IT: 4.2/SP: 3.7. Percentage of patients hospitalized ≥1 in the past-year was 5EU: 56%/UK: 40%/FR: 68%/DE: 65%/IT: 65%/SP: 57%.
Conclusions SLE patients experiencing flares had significant clinical and humanistic burden across the studied countries. Further scrutiny is warranted to assess the modalities of care delivered to this patient group to alleviate their burden.
Disclosure of Interest S. Narayanan Employee of: Ipsos, Y. Lu Employee of: Ipsos, R. Hutchings Employee of: Ipsos