Use of Antimalarial Agents Is Associated with Favourable Physical Functioning in Patients with Systemic Lupus Erythematosus
Abstract
:1. Introduction
2. Experimental Section
2.1. Study Design and Population
2.2. Evaluation of HRQoL
2.3. Evaluation of Disease Activity and Organ Damage
2.4. Patient Subgroups based on Organ-Specific Activity
2.5. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. MOS SF-36
3.3. FACIT-Fatigue
3.4. EQ-5D
3.5. Associations with SF-36 Physical Functioning
3.6. Stratification into Subgroups Based on Organ-Specific Activity
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Patient Characteristics | Pooled BLISS | AMA Use | p Value | |
---|---|---|---|---|
+ | − | |||
Number of Patients | 1684 | 1098 | 586 | |
Demographic Characteristics | ||||
Age (years) | 37.8 (11.5) | 36.8 (11.4) | 39.6 (11.5) | <0.001 |
Female sex | 1585 (94.1%) | 1033 (94.1%) | 552 (94.2%) | 0.922 |
Ethnicity | ||||
Asian | 353 (21.0%) | 243 (22.1%) | 110 (18.8%) | 0.107 |
Black/African American | 146 (8.7%) | 98 (8.9%) | 48 (8.2%) | 0.610 |
Indigenous American | 374 (22.2%) | 254 (23.1%) | 120 (20.5%) | 0.212 |
White/Caucasian | 798 (47.4%) | 491 (44.7%) | 307 (52.4%) | 0.003 |
Clinical Data | ||||
SELENA-SLEDAI score | 9.7 (3.8) | 9.6 (3.6) | 10.0 (4.0) | 0.145 |
SLE disease duration (years) | 6.4 (6.3) | 6.1 (6.2) | 7.0 (6.6) | 0.007 |
SDI score | 0.78 (1.24) | 0.69 (1.15) | 0.95 (1.37) | <0.001 |
SDI score = 0 | 977 (58.1%) | 673 (61.3%) | 304 (52.0%) | <0.001 |
Glucocorticoid use | 1453 (86.3%) | 929 (84.6%) | 524 (89.4%) | 0.006 |
Prednisone eq. dose (mg/day) | 10.8 (8.7) | 10.1 (8.5) | 12.1 (8.8) | <0.001 |
AMA use | 1098 (64.8%) | 1098 (100%) | N/A | N/A |
Hydroxychloroquine | 836 (49.6%) | 836 (76.1%) | N/A | N/A |
Chloroquine | 265 (15.7%) | 265 (24.1%) | N/A | N/A |
Other antimalarial agents * | 5 (0.3%) | 5 (0.5%) | N/A | N/A |
Hydroxychloroquine eq. dose (mg/day) | 219.6 (183.5) | 336.2 (111.0) | N/A | N/A |
Immunosuppressants | 816 (48.5%) | 476 (43.4%) | 340 (58.0%) | <0.001 |
Azathioprine | 389 (23.1%) | 221 (20.1%) | 168 (28.7%) | <0.001 |
Methotrexate | 231 (13.7%) | 144 (13.1%) | 87 (14.8%) | 0.325 |
Mycophenolic acid | 189 (11.2%) | 104 (9.5%) | 85 (14.5%) | 0.002 |
HRQoL Items | AMA Users | AMA Non-Users | p Value | MCID | |||
---|---|---|---|---|---|---|---|
Number of Patients | 638 | 353 | |||||
SF-36 | |||||||
Physical component summary | 39.63 | (9.31) | 37.82 | (9.76) | 0.006 | No | |
Mental component summary | 40.60 | (11.44) | 40.02 | (10.82) | 0.448 | No | |
Physical functioning | 61.46 | (24.71) | 54.16 | (26.58) | <0.001 | Yes | |
Role physical | 52.51 | (26.59) | 49.00 | (27.52) | 0.033 | No | |
Bodily pain | 48.81 | (22.71) | 46.17 | (24.82) | 0.038 | No | |
General health | 41.40 | (19.22) | 40.98 | (18.09) | 0.763 | No | |
Vitality | 43.86 | (21.34) | 41.91 | (21.33) | 0.175 | No | |
Social functioning | 60.63 | (25.14) | 57.01 | (25.01) | 0.043 | No | |
Role emotional | 61.13 | (27.44) | 58.96 | (27.07) | 0.165 | No | |
Mental health | 59.20 | (20.19) | 57.60 | (19.31) | 0.245 | No | |
FACIT-Fatigue | |||||||
Score | 30.32 | (11.74) | 28.87 | (12.09) | 0.077 | No | |
EQ-5D | |||||||
Utility index | 0.747 | (0.173) | 0.716 | (0.189) | 0.003 | No | |
VAS | 65.10 | (19.27) | 60.53 | (18.99) | <0.001 | No | |
EQ-5D Dimensions | |||||||
Mobility | L 1 | 377 | (60.2%) | 169 | (49.4%) | 0.001 | N/A |
L 2 | 249 | (39.8%) | 172 | (50.3%) | |||
L 3 | 0 | (0%) | 1 | (0.3%) | |||
Self-care | L 1 | 518 | (82.9%) | 261 | (75.9%) | 0.009 | N/A |
L 2 | 103 | (16.5%) | 78 | (22.7%) | |||
L 3 | 4 | (0.6%) | 5 | (1.5%) | |||
Usual activities | L 1 | 281 | (44.9%) | 118 | (34.3%) | 0.001 | N/A |
L 2 | 331 | (52.9%) | 213 | (61.9%) | |||
L 3 | 14 | (2.2%) | 13 | (3.8%) | |||
Pain or discomfort | L 1 | 116 | (18.6%) | 58 | (16.9%) | 0.510 | N/A |
L 2 | 460 | (73.6%) | 248 | (72.1%) | |||
L 3 | 49 | (7.8%) | 38 | (11.0%) | |||
Anxiety or depression | L 1 | 295 | (47.1%) | 132 | (38.4%) | 0.009 | N/A |
L 2 | 295 | (47.1%) | 196 | (57.0%) | |||
L 3 | 36 | (5.8%) | 16 | (4.7%) | |||
Full-health state | 77 | (12.3%) | 34 | (9.9%) | 0.262 | N/A |
HRQoL Items | AMA Users | AMA Non-Users | p Value | MCID | |||
---|---|---|---|---|---|---|---|
Number of Patients | 363 | 372 | |||||
SF-36 | |||||||
Physical component summary | 37.18 | (9.12) | 35.95 | (8.99) | 0.042 | No | |
Mental component summary | 40.22 | (11.39) | 40.08 | (11.58) | 0.903 | No | |
Physical functioning | 55.34 | (24.10) | 49.98 | (26.06) | 0.002 | Yes | |
Role physical | 48.87 | (25.78) | 46.27 | (25.87) | 0.131 | No | |
Bodily pain | 43.26 | (21.24) | 40.96 | (22.31) | 0.053 | No | |
General health | 38.89 | (18.83) | 39.94 | (17.45) | 0.298 | No | |
Vitality | 40.16 | (21.53) | 39.45 | (21.05) | 0.584 | No | |
Social functioning | 56.91 | (25.85) | 55.01 | (24.47) | 0.361 | No | |
Role emotional | 59.33 | (27.46) | 57.40 | (27.77) | 0.207 | No | |
Mental health | 58.54 | (19.68) | 57.80 | (20.50) | 0.654 | No | |
FACIT-Fatigue | |||||||
Score | 28.37 | (11.93) | 27.22 | (11.96) | 0.167 | No | |
EQ-5D | |||||||
Utility index | 0.706 | (0.182) | 0.684 | (0.195) | 0.080 | No | |
VAS | 61.76 | (19.91) | 59.21 | (18.28) | 0.042 | No | |
EQ-5D Dimensions | |||||||
Mobility | L 1 | 318 | (50.5%) | 157 | (43.9%) | 0.045 | N/A |
L 2 | 311 | (49.4%) | 200 | (55.9%) | |||
L 3 | 1 | (0.2%) | 1 | (0.3%) | |||
Self-care | L 1 | 491 | (78.2%) | 258 | (71.9%) | 0.026 | N/A |
L 2 | 132 | (21.0%) | 98 | (27.3%) | |||
L 3 | 5 | (0.8%) | 3 | (0.8%) | |||
Usual activities | L 1 | 230 | (36.7%) | 111 | (31.0%) | 0.072 | N/A |
L 2 | 374 | (59.6%) | 224 | (62.6%) | |||
L 3 | 23 | (3.7%) | 23 | (6.4%) | |||
Pain or discomfort | L 1 | 66 | (10.5%) | 31 | (8.6%) | 0.345 | N/A |
L 2 | 489 | (77.7%) | 276 | (76.9%) | |||
L 3 | 74 | (11.8%) | 52 | (14.5%) | |||
Anxiety or depression | L 1 | 261 | (41.4%) | 147 | (40.8%) | 0.855 | N/A |
L 2 | 326 | (51.7%) | 188 | (52.2%) | |||
L 3 | 43 | (6.8%) | 25 | (6.9%) | |||
Full-health state | 43 | (6.8%) | 20 | (5.6%) | 0.431 | N/A |
HRQoL Items | AMA Users | AMA Non-Users | p Value | MCID | |||
---|---|---|---|---|---|---|---|
Number of Patients | 112 | 67 | |||||
SF-36 | |||||||
Physical component summary | 40.70 | (9.88) | 39.39 | (11.87) | 0.471 | No | |
Mental component summary | 41.44 | (10.89) | 39.54 | (11.42) | 0.288 | No | |
Physical functioning | 60.69 | (26.23) | 57.93 | (28.50) | 0.547 | No | |
Role physical | 56.10 | (28.05) | 52.33 | (31.74) | 0.503 | No | |
Bodily pain | 54.42 | (26.78) | 49.28 | (31.18) | 0.149 | Yes | |
General health | 43.19 | (20.16) | 40.34 | (19.56) | 0.309 | No | |
Vitality | 46.27 | (22.28) | 44.40 | (24.19) | 0.516 | No | |
Social functioning | 62.39 | (25.14) | 56.90 | (26.68) | 0.138 | Yes | |
Role emotional | 63.58 | (25.69) | 57.90 | (27.58) | 0.183 | Yes | |
Mental health | 59.99 | (19.73) | 57.87 | (19.89) | 0.545 | No | |
FACIT-Fatigue | |||||||
Score | 32.19 | (11.64) | 30.03 | (13.11) | 0.357 | No | |
EQ-5D | |||||||
Utility index | 0.768 | (0.206) | 0.733 | (0.221) | 0.286 | No | |
VAS | 65.61 | (21.59) | 59.86 | (19.48) | 0.041 | No | |
EQ-5D Dimensions | |||||||
Mobility | L 1 | 69 | (63.9%) | 35 | (53.0%) | 0.156 | N/A |
L 2 | 39 | (36.1%) | 31 | (47.0%) | |||
L 3 | 0 | (0%) | 0 | (0%) | |||
Self-care | L 1 | 84 | (78.5%) | 54 | (81.8%) | 0.598 | N/A |
L 2 | 22 | (20.6%) | 12 | (18.2%) | |||
L 3 | 1 | (0.9%) | 0 | (0%) | |||
Usual activities | L 1 | 52 | (48.6%) | 30 | (45.5%) | 0.688 | N/A |
L 2 | 54 | (50.5%) | 32 | (48.5%) | |||
L 3 | 1 | (0.9%) | 4 | (6.1%) | |||
Pain or discomfort | L 1 | 33 | (30.8%) | 22 | (33.3%) | 0.732 | N/A |
L 2 | 63 | (58.9%) | 35 | (53.0%) | |||
L 3 | 11 | (10.3%) | 9 | (13.6%) | |||
Anxiety or depression | L 1 | 59 | (54.6%) | 23 | (34.8%) | 0.011 | N/A |
L 2 | 45 | (41.7%) | 37 | (56.1%) | |||
L 3 | 4 | (3.7%) | 6 | (9.1%) | |||
Full-health state | 27 | (25.0%) | 13 | (19.7%) | 0.420 | N/A |
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Gomez, A.; Soukka, S.; Johansson, P.; Åkerström, E.; Emamikia, S.; Enman, Y.; Chatzidionysiou, K.; Parodis, I. Use of Antimalarial Agents Is Associated with Favourable Physical Functioning in Patients with Systemic Lupus Erythematosus. J. Clin. Med. 2020, 9, 1813. https://doi.org/10.3390/jcm9061813
Gomez A, Soukka S, Johansson P, Åkerström E, Emamikia S, Enman Y, Chatzidionysiou K, Parodis I. Use of Antimalarial Agents Is Associated with Favourable Physical Functioning in Patients with Systemic Lupus Erythematosus. Journal of Clinical Medicine. 2020; 9(6):1813. https://doi.org/10.3390/jcm9061813
Chicago/Turabian StyleGomez, Alvaro, Sofia Soukka, Petter Johansson, Emil Åkerström, Sharzad Emamikia, Yvonne Enman, Katerina Chatzidionysiou, and Ioannis Parodis. 2020. "Use of Antimalarial Agents Is Associated with Favourable Physical Functioning in Patients with Systemic Lupus Erythematosus" Journal of Clinical Medicine 9, no. 6: 1813. https://doi.org/10.3390/jcm9061813