Systemic lupus erythematosus (SLE) treatments try to efficiently manage the disease while being safe and carrying a low rate of adverse events. Different strategies are currently used to control disease activity and prevent organ damage. To further understand if SLE is being adequately treated, a team of researchers lead by Dr. Christine Peschken looked at disease activity among patients from various hospitals and clinics in Canada.
SLE is an autoimmune disease in which the body’s immune system mistakenly attacks healthy tissue affecting many internal organs in the body. This disease most often harms the heart, joints, skin, lungs, blood vessels, liver, kidneys, and nervous system. In clinical practice, disease activity and severity are assessed using a combination of clinical history, physical examination, organ-specific tests, and serologic studies to determine the appropriate therapeutic approach.
In this multiple site study, the authors included 1,454 SLE patients, 35% displaying active or highly active disease as shown by the SLE disease activity index (SLEDAI2K) after a mean disease duration of more than 10 years. Less controlled patients were more prone to have shorter disease duration, increased organ damage and higher use of more aggressive treatments such as prednisone – a type of corticosteroid or cortisone-like medication – and cyclophosphamide. Nevertheless, even among low and moderate disease activity patients, more than half received more than 7.5 mg of daily prednisone.
The use of corticosteroids has numerous side effects, some of which may be severe, specially with long term use. Examples of these side effects are altered response to physical stress, risk of infection, gastrointestinal ulcers or bleeding, osteoporosis, weight gain, mood changes, high blood pressure, elevated sugar levels, atherosclerosis (hardening of the arteries) and eye problems such as cataracts or glaucoma. As such, their use should be reserved to patients with a more active and/or difficult to control disease.
Considering the high rate of both active lupus and also of patients with low or moderate activity disease requiring high doses of prednisolone, this study highlights the need for more optimized SLE treatments.