Abstract
Objective The heterogeneity of systemic lupus erythematosus (SLE) poses a challenge in clinical care. Several treatment options are available, but data on immunomodulating drug survival in SLE is limited, warranting further investigation to optimize treatment strategies.
Methods The Vienna Lupus Cohort encompasses SLE patients treated at the outpatient clinic of the Division of Rheumatology at the Vienna General Hospital. Patient data, including measures of disease activity, type of medication, start- and end-date as well as reason for discontinuation, were entered into a specified database. Every initiation of an immunomodulating medication was considered a treatment cycle. Drug survival analyses using a Kaplan-Meier estimator was done for treatment cycles as well as for individual drugs, however excluding Cyclophosphamide and integrating Chloroquine and Hydroxychloroquine into one group.
Results 428 treatment cycles in 178 patients were analyzed. Patient were on average 35.1 (± 13.1) years old at initiation of their first DMARD therapy, and 158 (89%) were female. Time of observation ranged from 1987 to 2023. Overall, treatment cycle three and the following cycles had longer drug survival as treatment cycle one or two. Among the four most frequent treatments, Methotrexate (MTX), Azathioprine (AZA), Chloroquine/Hydroxychloroquine (H/CQ) and Mycophenolate (MMF), drug survival rates were higher for H/CQ and MMF compared to the other therapies (figure 1). Most frequent reasons for drug discontinuation were objective side effects, insufficient efficacy, followed by subjective side effects and non-compliance (table 1).
Drug survival by medications: Azathioprine (red), (Hydroxy)-chloroquine (green), Mycophenolate (blue), Methotrexate (purple)
Conclusions This real-life data suggests favourable drug survival rates in SLE, especially with MMF and (H)CQ. The reasons for drug discontinuation in SLE are diverse. Further assessment of more recent treatment strategies, especially biologicals might offer additional insights.
Acknowledgements The SLE database was supported by AstraZeneca.
