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Abstract
Objective The Lupus Clinic at University College London Hospital (UCLH) has been recruiting patients since 1979.We carried out a comprehensive study of the records of patients from the clinic to study changes in management and outcomes during different time periods. In this abstract we test hypotheses that cyclophosphamide would have been replaced by mycophenolate and biologics, and that patients in earlier time periods were presenting later and with more severe disease.
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 divided them into 12 equal groups based on date of starting follow-up in order to delineate changes over time. The final group was recruited between 2009–11. We didn’t include patients recruited after 2011 to ensure that follow-up of 10 years was possible for all patients in the study.
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. Figure 1 shows that use of cyclophosphamide fell steeply twice, first when mycophenolate was introduced and then to almost zero with increasing use of biologics. Rituximab was by far the most common biologic used, comprising 92% of cases. In the earliest four time groups >60% patients presented with more severe symptoms (i.e. not limited to skin and joints) whereas this was not true in the most recent groups. There was no definite change in mean age at presentation over time. Taking mortality within 10 years of presentation as a marker of disease severity, this has fallen to almost zero in the more recent time groups (figure 2).
Conclusions Mycophenolate and rituximab have largely replaced use of cyclophosphamide. Mortality within 10 years has improved.
Acknowledgements This research was carried out in a unit supported by the UCL/UCLH Biomedical Research Centre.
Changes in use of cyclophosphamide, mycophenolate and biologics over time
Percentage of each group that died within 10 years and their severity of symptoms
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