ACR2012 Highlights: Systemic Lupus Erythematosus

Noteworthy reports about lupus at the recent American College of Rheumatology meeting included biomarkers for non-cardiovascular comorbidities, information about thrombosis and cancer risk with medications, and epratuzumab returns with some good news. (To read the abstracts for these reports, click on the abstract number below.)

•  The same biomarkers associated with atherosclerotic cardiovascular disease in systemic lupus erythematosus (SLE) are also associated with other kinds of damage due to the disease, such as renal or pulmonary. In 159 SLE patients, 4 biomarkers (pro-inflammatory HDL, leptin, sTWEAK and homocystine), age, and oxidative stress were associated with atherosclerotic heart disease. Those factors were also associated with non-atherosclerotic damage. High oxidative stress was associated with a 2.9-fold increase, and lifetime prednisone >20g was associated with a 2.6-fold increase. (Abstract #1709)

•  Epratuzumab improved health-related quality of life in a followup study. Two randomized, controlled phase 3 trials of epratuzumab for SLE were terminated because of drug manufacturing problems. Those problems resolved, the same patients were invited back into an open-label extension study. After the phase 3 trials, patients had clinically significant improvements in their health-related quality of life scores. During the 4 years of the extension study, that improvement was maintained or increased. (Abstract #2252)


•  Immunomodulators were not associated with increased lymphoma risk. A case-cohort analysis, with 64 lymphomas and 4,739 controls, could not demonstrate an association between lymphoma and cyclophosphamide, azathioprine, methotrexate, mycopenolate, anti-malarials or glucorticoids for SLE. Cyclophosphamide had a trend towards 2-fold lymphoma risk, but it disappeared in fully adjusted models. The object of the study was to untangle the relative contributions of disease activity and drug exposure, but solving that will require further work. (Abstract #2570)

• Hydroxychloroquine reduced thrombosis risk, but prednisone increased it. Among 1,795 SLE patients, 193 thrombotic events occurred over 10,508 person-years. After univariate and multivariate analysis, a prednisone dose >20mg/day had a hazard ratio of 4.4 for thrombosis. Hydroxychloroquine reduced thrombosis, with a hazard ratio of 0.6. (Abstract #2569)