AB1007 EVALUATION OF CHANGES IN SLE PATIENTS’ DISEASE ACTIVITY, DAMAGE AND THERAPY AT DIAGNOSIS AND DURING FOLLOW UP IN THE LAST FORTY YEARS: PRELIMINARY DATA OF A SINGLE CENTER EXPERIENCE
Authors: S. E. L. Della Pina, C. Barison, C. Orlandi, M. Tedeschi, C. Mai, C. Nalli, M. Fredi, F. Franceschini
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> In Systemic Lupus Erythematosus (SLE) early diagnosis and therapeutic advances have led to better improve outcomes, however increased morbidity and mortality remain. Achievement of persistent low disease activity and/or remission have been associated with reduced long-term organ damage. The role of glucocorticoids (GCs) as cause of damage has been clearly established and treat-to-target recommendations in SLE advocate the use of the lowest GC dosage needed for the shortest duration and, if possible, its complete withdrawal. A GC-sparing effect has been also demonstrated for several immunosuppressive agents. <h3>Objectives:</h3> The aim of this study was to evaluate the changes in SLE patients' assessment and therapy at diagnosis and during the follow-up. <h3>Methods:</h3> Medical records of 264 patients diagnosed with SLE between 1970 to 2019 and followed up at our Lupus Clinic were reviewed. Patients were divided into 4 groups based on the year of diagnosis: 1970-'89, 1990-'99, 2000-'09, 2010-'19. Disease activity, cumulative organ damage and remission were recorded according to validated indices such as SLEDAI-2K, SLEDAS, SLICC Damage Index, LLDAS and 2021 DORIS remission at the time of diagnosis (T0), at 1 (T1), 5 (T5), 10 (T10) years after the diagnosis and at the last evaluation (TL). GCs (both in absolute terms and daily dosage), hydroxychloroquine (HCQ) and DMARDs use were also evaluated at the same time points. Categorical variables were reported as proportion and/or percentage, continuous variables were expressed as mean (±standard deviation) values. Continuous variables were compared using one-way Anova or Mann-Whitney test, categorical variables with Chi-Squared or Fisher's exact test. P values &lt;0.05 were considered statistically significant. <h3>Results:</h3> Significant comparisons between decades are detailed in Table 1 and in Table 2. Evaluating patients at the time of diagnosis through the different decades, no significant changes were found in either index of disease activity or damage, nor in the administered therapies with the exclusion of the early use of HCQ: from less than 50% before 1999, to more than 70% of patients diagnosed in the following two decades (p &lt;0.0001). As for disease activity, a significant variation in the different decades appears at T1 with a higher number of patients reaching LLDAS (p=0.0071) and DORIS (p=0,0090); similar results were confirmed at T5 for both LLDAS (p&lt;0,0001) and DORIS (p&lt;0,0001) and with the evidence also of a reduction in SLEDAI-2K (p=0.0022). As for SLICC a reduction appears at TL (p&lt;0.0001). As for the use of GCs, a significant decrease in absolute number of patients treated during the decades was observed at T5 (p=0,0349) and at T10 (p=0,0012), furthermore a significant reduction in GCs daily dose was observed at T1, T5 and T10 (p=0,0057, p&lt;0.0001 and p&lt;0.0001 respectively). Finally, an increased use of HCQ was also observed at all time point (p&lt;0.0001) and for DMARDS an increased use was observed for T5, T10 and TL (p=0,0111, p=0,0003, p=0,0007 respectively). <h3>Conclusion:</h3> Our preliminary data reflect the therapeutic improvements of the past decades, characterized by a reduction in the use of GCs both in absolute terms and in daily dosage. Furthermore, a greater and earlier use of antimalarials and immunosuppressive agents such as HCQ and DMARDs and a more rapid achievement of remission were highlighted. The efficacy of HCQ is well established not only in reducing the risk of SLE flares, but also for its beneficial effects on SLE-related comorbidities, including diabetes, thrombotic events, and dyslipidemia, which contribute to long-term damage and to death. Thus, these therapeutic improvements could help to improve outcomes in SLE patients. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>