Background Systemic lupus erythematosus (SLE) is heterogeneous in its clinical presentation, course, and prognosis and lupus nephritis (LN) continues to be a major cause of morbidity and mortality among children and adults with SLE. Up to 60% of adult and 80% of pediatric SLE patients (pts) will eventually develop overt renal disease . To date the excess burden of comorbidities, risk of inpatient hospitalization, and in-hospital death associated with SLE and LN remains incompletely understood.
Objectives To identify differences in comorbidities, hospitalizations, and in-hospital mortality of SLE and LN cohorts compared to: 1) each other; 2) reference populations of pts without an autoimmune condition (non-AI) matched on gender and age. Reference populations were allowed to have claims for non-autoimmune conditions.
Methods We conducted a retrospective cohort study using the Truven Healthcare MarketScan® Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits database, which together comprise 65 million insured US lives between 1999 and 2014. Cohort identification is based on validated algorithms [2, 3] for identification of pts with either LN or SLE without renal involvement using claims data. Pts were matched on age and gender at index date. All eligible participants had 365 days of enrollment prior to and after the index date. End of study for post-index follow-up was captured as whichever of the following occurred first: 1) end of enrollment; 2) end of database; 3) date of death. Results are presented separately for pediatric and adult pts.
Results 54,813 SLE pts without renal involvement and 8,839 LN pts were identified and matched to reference non AI populations. Compared to the non-renal SLE cohort, pts in the LN cohort were older (49.9±16.6 vs. 48.6±14.3 years) with a higher proportion of males (15.4% vs. 11.2%). Pts with LN had the highest scores on the Charlson Comorbidity Index modified to exclude renal involvement (Table 1). Additionally, adults with LN had higher rates of hospitalizations and longer hospitalizations compared with adults with non-renal SLE, who already had higher rates of hospitalizations and longer hospitalizations than matched controls (Table 2). This pattern of findings was consistent for children. Rates of in-hospital mortality were highest among those with LN but also increased among those with SLE compared with matched controls (Figure 1).
Conclusions An SLE diagnosis was associated with a higher burden of comorbidities and higher rates of hospitalizations and in-hospital mortality than non-AI matched controls. Pts with LN had the highest burden of comorbidities and rates of hospitalizations and in-hospital mortality. SLE and LN impose a high burden of morbidity and mortality and the medical need for safe and effective treatments of LN and SLE remains unmet. Clinicians should consider these factors in their assessment and treatment of pts with SLE and LN. The retrospective, claims-based results do not permit pt-level assessment of the relative contributions of disease, treatment, and potential confounders to these findings.
Cameron JS. J Am Soc Nephrol, 1999;10:413–24.
Arkema EV et al. BMJ open, 2016;6:e007769.
Chibnik LB et al. Lupus, 2010;19:741–3.
Disclosure of Interest K. Belendiuk Employee of: Genentech, Inc., H. Trinh Employee of: Genentech, Inc., M. Cascino Employee of: Genentech, Inc., L. Dragone Employee of: Genentech, Inc., D. Keebler Employee of: Genentech, Inc., J. Garg Employee of: Genentech, Inc.