AB1056 ACCELERATED DAMAGE ACCRUAL IN PATIENTS WITH LONG-STANDING SLE RECEIVING GLUCOCORTICOIDS
Authors: M. B. Cilona, G. A. Ramirez, S. Nannipieri, L. Moroni, E. Bozzolo, M. Matucci-Cerinic, L. Dagna
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disease characterised by significant morbidity. Corticosteroids are the mainstay of treatment but also associate with damage accrual, with evidence suggesting high risk even with short exposures to naïve subjects [1]. Current guidelines suggest a target prednisone dose ≤5mg/day to minimize its detrimental impact [2]. Little is known about the effectiveness of this target in patients with long-standing disease [3]. <h3>Objectives:</h3> To assess whether short-term exposure to high-dose corticosteroids affects damage accrual in patients with SLE flares after diagnosis. <h3>Methods:</h3> We performed a retrospective analysis of prospectively collected data of 206 patients with SLE followed-up from January 2015 to December 2023. Inclusion criteria were: 1) SLE with a flare after remission from the onset manifestations; 2) availability of ≥2 visits after flare acknowledgement. Patients unable to reduce prednisone dose to ≤5mg/day throughout the follow-up were categorised as high-dose group and compared to the remainder patients (low-dose group). Demographics, SLE clinical history, baseline diseases features, and organ involvement were evaluated. We used Cox regression to estimate the cumulative damage progression rate in the two groups. Organ involvement was assessed with the British Isles Lupus Assessment Group (BILAG) index. Disease activity was also quantitated with the SLE disease activity index 2000 (SLEDAI-2K) along with a 0.0-3.0 physician global assessment scale (PGA). Damage was assessed with the SLE International Collaborating Clinics/American College of Rheumatology Damage index (SDI). Data are expressed as mean ± standard deviation (SD), unless otherwise specified. <h3>Results:</h3> The study sample consisted in 129 patients (63%) receiving low-dose and 77 (37%) high-dose prednisone. There were no significant differences in terms of sex, age and disease duration between groups. Compared to patients treated with low-dose steroids, patients in the high-dose group had a higher prevalence of skin manifestations, especially of alopecia and cutaneous vasculitis in their history, along with a higher frequency of cardiac involvement and lymphadenopathy (Table 1). The mean disease duration at time of flare was 11±8 years in the high-dose group and 15± 9 years in the low-dose group. Patients in the high-dose group at SLE flares had a higher SLEDAI-2k (7 ± 6 vs 3 ± 2, p&lt;0.001) PGA scores (1.5±0.8 vs 0.5±0.4, p&lt;0.001) compared to the low-dose group. In patients with high-dose prednisone, SLE flares at presentations were characterised by prominent activity in the renal (21% vs 16%, p=0.006), mucocutaneous (31% vs 14%, p=0.003), and constitutional BILAG domain (10% vs 3%, p=0.030) compared to patients in the low-dose group. Over time, patients in the high-dose group had a higher risk of SDI progression compared to patients treated with lower steroid doses (HR=2.55, 95% CI, 1.17 to 5.53; p=0.02; <b>Figure 1</b>. SDI progression occurred early in the treatment course, with an estimated 12% vs 3% 24-month damage accrual incidence in the high- and low-dose group, respectively. <h3>Conclusion:</h3> Patients with long-standing SLE treated with prednisone doses &gt;5mg/day are characterised by broader disease extent and rapidly accrue damage even with relatively short exposure to corticosteroids, consistent with observations in reacent-onset subjects [1]. Prednisone doses ≤5mg/day significantly minimise, although do not abate damage accrual in patients with longstanding SLE. <h3>REFERENCES:</h3> [1] Floris A, et al., RMD Open. 2022 [2] Fanouriakis A, et al., Ann Rheum Dis. 2023 [3] Gerosa M, et al., J Clin Med. 2022 <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>