Lorenzo-Vizcaya Ana, Isenberg David
Department of Internal Medicine, Hospital Universitario De Ourense, Ourense, Spain.
Department of Rheumatology, Division of Medicine, University College London, London, UK.
Lupus. 2021 Apr;30(5):702-706. doi: 10.1177/0961203320988607. Epub 2021 Jan 20.
Systemic Lupus Erythematosus (SLE) an autoimmune rheumatic disease with a complex pathogenesis, remains potentially life-threatening. SLE patients have increased morbidity and premature mortality compared to non-SLE patients. The five-year survival rate has improved from <50% in the 1950s to >90% in the 1980s. Lupus patients still have a mortality risk three times that of the general population.
To provide a detailed analysis of the causes of death, main characteristics and trends in the management of the deceased SLE patients from the lupus clinic at the University College London Hospital (UCLH); during the past four decades.
This was a non-interventional, retrospective study based on historical real-world data from paper and electronic records of patients followed up at UCLH. The analysis focused on data collected between 1st January 1978 and 31th December 2018. We collected the: causes of death, duration of disease, key laboratory and clinical parameters and the treatment received. We compared the results from the four decades to ascertain trends in the causes of mortality. All statistical analyses were performed using the Statistical Package for Social Sciences (SPSS), version 22.0. The 95% confidence intervals for the means of data were calculated.
111 SLE patients (15%), died during follow-up. Their median age was 51 years (interquartile range (IQR) = 38-63 years) and the median duration of disease, 15 years (IQR = 8.5-24 years). The main causes of death in the past 40 years were infection (31.7%), cancer (26.7%) and cardiovascular disease (CVD) (21.8%). 93.6% of these patients were immunosupressed. During the 40-year period, there were several therapeutic developments notably the introduction of mycophenolate mofetil (MMF) and rituximab; the latter initially only given to patients when more conventional inmunosupressants had failed, but more recently offered to patients at diagnosis. There was a statistically significant increase in the use of hydroxycloroquine (HCQ), MMF and rituximab. In contrast, the use of Azathioprine (AZA) and steroids, hardly changed over time.
This retrospective review shows how epidemiological factors, causes of death and treatment of SLE patients have changed during the last 40 years in the UCLH cohort.
系统性红斑狼疮（SLE）是一种发病机制复杂的自身免疫性风湿疾病，仍具有潜在的生命威胁。与非SLE患者相比，SLE患者的发病率和过早死亡率有所增加。其五年生存率已从20世纪50年代的<50%提高到20世纪80年代的>90%。狼疮患者的死亡风险仍是普通人群的三倍。
详细分析伦敦大学学院医院（UCLH）狼疮门诊过去四十年来已故SLE患者的死亡原因、主要特征及治疗趋势。
这是一项基于UCLH纸质和电子记录的历史真实世界数据的非干预性回顾性研究。分析聚焦于1978年1月1日至2018年12月31日期间收集的数据。我们收集了：死亡原因、疾病持续时间、关键实验室和临床参数以及接受的治疗。我们比较了这四十年来的结果，以确定死亡率原因的趋势。所有统计分析均使用社会科学统计软件包（SPSS）22.0版进行。计算了数据均值的95%置信区间。
111例SLE患者（15%）在随访期间死亡。他们的中位年龄为51岁（四分位间距（IQR）=38 - 63岁），疾病中位持续时间为15年（IQR = 8.5 - 24年）。过去40年的主要死亡原因是感染（31.7%）、癌症（26.7%）和心血管疾病（CVD）（21.8%）。这些患者中有93.6%接受了免疫抑制治疗。在这40年期间，有多项治疗进展，特别是霉酚酸酯（MMF）和利妥昔单抗的引入；后者最初仅在更传统的免疫抑制剂治疗失败时给予患者，但最近在诊断时就给予患者使用。羟氯喹（HCQ）、MMF和利妥昔单抗的使用有统计学显著增加。相比之下，硫唑嘌呤（AZA）和类固醇的使用随时间变化不大。
这项回顾性研究表明了UCLH队列中SLE患者的流行病学因素、死亡原因和治疗在过去40年里是如何变化的。
