[ACR22] Systemic Lupus Erythmatosus and Antiphospholipid Syndrome

Author: Cristiana Sieiro Santos

Luong et al. (0320) described the use of metabolomic analysis of metabolites to identify biomarkers of disease activity or adverse pregnancy outcomes (APO) in SLE. Low-density lipoproteins (LDL) correlated with disease activity measured using the BILAG index in non-pregnant and pregnant SLE groups. HDL correlated with pre-eclampsia and pregnancy-induced hypertension in SLE pregnancy.

Nguyen et al. (0343) assessed the associations of baseline severe non-adherence to hydroxychloroquine (HCQ), objectively assessed by HCQ serum levels, and risks of SLE flares, damage, and mortality over 5 years of follow-up in 660 patients from SLICC Inception Cohort. Severe non-adherence was independently associated with the risk of SLE flare in the following year, with early damage, and 5-year mortality.

Fava et al. (0536) evaluated the urine proteomic profiles in lupus nephritis (LN) to identify early predictors of proteinuric response by quantifying 1200 biomarkers in urine samples collected on the day of or within 3 weeks of kidney biopsy and week 12, 24, or 52 in LN patients (ISN class III, IV, V, or mixed) with proteinuria > 1 g/d. Biomarkers of immunological response outperformed early decline of urine protein-to-creatinine ratio, in predicting 1-year proteinuric response, especially in proliferative LN.

Morand et al. (1595) assessed long-term associations of sustained LLDAS with protection from damage accrual and flare. LLDAS was associated with significant protection against subsequent damage accrual (HR 0.60, 95%CI 0.52-0.69, p<0.001) and flare (HR 0.57, 95%CI 0.53-0.61, p<0.001). 71.6% of patients sustained LLDAS for >3 months. Increasing durations of sustained LLDAS from >3 to >24 months corresponded to increased protective effects against damage and flare, whether measured as a dose effect or as a threshold.

Schett et al (1651) presented the results of CD19 CAR-T cells treatment in severe/refractory SLE patients.  Five SLE patients were treated and all experienced sustained drug-free remission meeting Lupus Low Disease Activity State (LLDAS) and DORIS remission criteria of SLE. Anti-dsDNA antibodies seroconverted and in the two patients with longer follow up ANA became also negative. All patients remained off immunosuppressive drugs including glucocorticoids.

Kalunian et al. (1652) described long-term safety and efficacy results of anifrolumab 300 mg vs placebo in patients who completed one year in a phase 3 TULIP trial, plus up to 3 years of participation in the TULIP long-term extension (LTE) study. A favorable benefit–risk profile for anifrolumab was maintained throughout the 3-year long-term extension of the TULIP-1 and TULIP-2 trials.

Arriens et al. (1653) report the recently completed AURORA 2 continuation study evaluating voclosporin compared to control in patients treated for an additional two years after AURORA 1. Voclosporin was well-tolerated over three years of treatment. The significant reductions in proteinuria initially achieved in AURORA 1 were maintained throughout AURORA 2, and more patients in the voclosporin arm achieved a good renal outcome. These data provide evidence of a long-term treatment benefit of voclosporin in patients with LN.

Petri et al. (2068) presented the pattern of mortality in a single long-term, prospective cohort using death certificates to document cause of death. The four leading primary causes of death were: lupus (23%), cardiovascular (23%), cancer (15%) and  infection (13%). African-Americans died at a younger age compared to Caucasians (50 ± 15 years vs 58 ± 16 years, p< 0.001) but had a higher proportion of deaths from infections and renal causes (p=0.0017).

Calvo et al. (2095) presented the data of the RELESSER-PROS registry regarding validation of the physician global assessment (PGA), in the Spanish population, analyzing the correlation with SLEDAI and its ability to predict damage in order to promote its more widespread use. They show that correlation between PGA and SLEDAI is low and both should be used together. PGA could improve the assessment of disease activity and its use adds the possibility to improve damage prediction.

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