Abstract Background/Aims The Lupus Clinic at University College London Hospital has been running since 1978. Patients who satisfy classification criteria for lupus have been followed long-term with their clinical data recorded. In previous work, we divided patients into groups according to year of entry into the cohort and found that patients who entered between 2006-2011 had better survival in Kaplan-Meier analysis than those who entered earlier. There was some indication that improved outcomes might be related to changing patterns of drug use and clinical presentation in the group of patients recruited between 2006 and 2011. We wanted to extend the study to include later time groups in order to find out whether patients who were recruited between 2011 and 2020 also showed these patterns. Methods We carried out detailed analysis of the medical and research records of 655 patients with SLE who had been seen in the clinic. Forty patients were excluded because they were only followed up for a very short time and/or because key information was not available. Fifteen patients had been recruited from 2020 onwards when clinical practice changed due to the Covid pandemic and were excluded. The remaining 600 patients were divided into 20 groups of 30 on the basis of year of entering the cohort. For each group we noted the following outcomes; ever-use of cyclophosphamide, ever-use of mycophenolate, ever-use of biologics, symptoms at presentation and lifetime damage (yes/no). Damage was assessed using the Systemic Lupus International Collaborative Clinics Damage Index. The symptoms at presentation were classified as mild (mucocutaneous, musculoskeletal and/or changes in blood counts only) or severe (any other presentation). Results Analysis of drug use showed a clear pattern of decline in use of cyclophosphamide from 2013 onwards. Ever-use of mycophenolate began to rise from the group recruited from 1994 onwards and biologics from 2001 onwards with plateau in ever-use in 50% of patients for mycophenolate and 40% for biologics in all groups recruited after 2009. Mild and severe presentations were roughly equal till 2015 after which 60% of all new patients presented with milder features. There was a decline in lifetime damage starting after 2013, whereas all groups recruited up to 2005 had 60% prevalence of lifetime damage, all groups recruited after 2013 had 30% prevalence of lifetime damage. Conclusion This long-term study suggests that patients entering this cohort of patients with systemic lupus erythematosus managed at a single centre have presented with milder manifestations and developed less lifetime damage over the past decade. The use of cyclophosphamide has fallen dramatically whereas ever-use of mycophenolate and biologics have risen to plateaus of about 50% and 40% respectively in patients recruited after 2009. Disclosure N. Rege: None. M. Pisliakova: None. G.S. Uzun: None. D.A. Isenberg: None. A. Rahman: None.
Rege et al. (Wed,) studied this question.