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Abstract
Objective The Lupus Clinic at University College London Hospital (UCLH) has been recruiting patients since 1978.We carried out a comprehensive study of the records of patients from the clinic to study changes in management and outcomes in different groups of patients. In this abstract we investigate differences in management and outcome between patients of different sex, ethnicity and age at presentation.
Methods The study population consists of 359 patients recruited to the cohort between 1978 and 2011 for whom we have comprehensive data regarding start and end of follow-up, demography, ever-use of cyclophosphamide, mycophenolate and/or biologics, presenting features and mortality. The median length of follow-up was 14 years (min 0.5, max 40). In this study we classified them into groups according to sex, ethnicity (White, African/Caribbean, South Asian, East Asian and other) and age at time of presentation to UCLH (classified as either above or below the median, which was 29 years).
Results Overall, 79 patients ever received cyclophosphamide, 98 mycophenolate and 107 biologics. Fifty-two patients died of whom 21 died within 10 years of presentation. Table 1 shows the differences between groups in terms of clinical manifestations at presentation and mortality within 10 years of presentation. African/Caribbean and South Asian patients were significantly more likely to present with features outside skin and joints as were those diagnosed younger. Figure 1 shows differences between groups in use of cyclophosphamide, mycophenolate and biologics.
Conclusions We found no significant differences between men and women, perhaps because there were too few men in the study. South Asian and African/Caribbean patients were more likely to present with more severe clinical manifestations and were also more likely to receive cyclophosphamide, mycophenolate or biologics than white patients. Cyclophosphamide was especially used in South Asians. Patients diagnosed below the age of 29 years had more severe clinical manifestations at presentation and were more likely to receive cyclophosphamide, mycophenolate or biologics than those diagnosed above that age.
Acknowledgements This research was carried out in a unit supported by the UCL/UCLH Biomedical Research Centre.
Use of cyclophosphamide, mycophenolate and biologics in different groups
Mortality within 10 years, and severity of presenting manifestations
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