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Natural history of disease activity and damage in patients with cutaneous lupus erythematosus - 10/11/18

Doi : 10.1016/j.jaad.2018.06.040 
Khor Jia Ker, MRCP a, b, Noelle M. Teske, MD c, Rui Feng, PhD d, Benjamin F. Chong, MD, MSCS c, , Victoria P. Werth, MD b, e,
a National Skin Centre, Singapore, Singapore 
b Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania 
c Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas 
d Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania 
e Medical Research, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania 

Reprint requests: Benjamin F. Chong, MD, MSCS, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9069.University of Texas Southwestern Medical Center5323 Harry Hines BlvdDallasTX75390-9069Victoria P. Werth, MD, Department of Dermatology, Perelman Center for Advanced Medicine, Ste 1-330A, 3400 Civic Center Blvd, Philadelphia, PA 19104.Department of DermatologyPerelman Center for Advanced MedicineSte 1-330A, 3400 Civic Center BlvdPhiladelphiaPA19104

Abstract

Background

Long-term studies characterizing disease course of cutaneous lupus erythematosus (CLE) patients on standard-of-care treatments are lacking.

Objective

We characterized and compared disease course of CLE patients using Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI).

Methods

In total, 83 CLE patients with CLASI scores collected from ≥3 study visits within 2 years had disease activity and damage trends calculated by average change scores (ACS). Trends were classified as improved (ACS ≤−3), worsened (ACS ≥3), or stable (–3 < ACS < 3). Linear regression models compared CLASI trends between groups.

Results

Most patients (72.73%) with initial CLASI activity (CLASI-A) scores >9 (N = 33) had improved disease activity versus 14.00% of those with initial CLASI-A scores ≤9 (N = 50). Linear regression analyses showed significant improvement in CLASI-A scores in patients of minority races (P < .05), with baseline CLASI-A scores >9 (P < .0001), baseline CLASI damage (CLASI-D) scores ≥10 (P = .0001), and CLE disease duration ≤1 year (P = .01). Of 28 patients with baseline CLASI-D scores ≥10, 35.71% had improvements in damage, while 5.26% of patients with initial CLASI-D scores of 5-9 (N = 19) and 0% with initial CLASI-D scores <5 (N = 36) (P = .0005) had improvements.

Limitations

Limitations include small sample size.

Conclusion

Baseline CLASI-A score >9, minority race, and short disease duration predict CLE disease activity improvement. A baseline CLASI-D score ≥10 is associated with disease damage improvement.

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Key words : Cutaneous Lupus Disease Area and Severity Index, cutaneous lupus erythematosus, disease activity, disease damage, longitudinal

Abbreviations used : ACS, CLASI, CLASI-A, CLASI-D, CLE, DLE, SCLE, SLE


Plan


 Drs Chong and Werth are co-senior authors for this manuscript.
 Funding sources: Supported by an internal grant awarded by Biogen Incorporated, the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (award no. K23AR061441 to Dr Chong and K24AR02207 to Dr Werth), the Rheumatology Research Foundation Career Development Bridge Funding Award (to Dr Chong) and the United States Department of Veterans Affairs (Veterans Health Administration, Office of Research and Development and Biomedical Laboratory Research and Development) (to Dr Werth).
 Conflicts of interest: Dr Chong has received research grants (paid to his institution) from Biogen Incorporated and Daavlin Corporation. Dr Chong is an investigator for Pfizer Incorporated and has also received an honorarium from Celgene Corporation. Dr Werth has received research grants from Celgene Corporation, Janssen, Pfizer, Biogen, Corbus Pharmaceuticals, LuCIN, Genentech, Syntimmune, and AstraZeneca and honoraria from Celgene, Medimmune, Resolve, Neovacs, ACI, Immune Pharmaceuticals, Genetech, Idera, Octapharma, BSL Behring, Janssen, Lilly, Pfizer, Biogen, BMS, Biostrategies, Gilead, Amgen, Medscape, Principia, Nektar, Syntimmune, Incyte, and EMD Sorona. The University of Pennsylvania owns the copyright for the Cutaneous Lupus Erythematosus Disease Area and Severity Index. The remaining authors have no conflicts of interest to disclose.
 Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of The University of Texas Southwestern Medical Center at Dallas and its affiliated academic and health care centers, University of Pennsylvania School of Medicine, the National Center for Research Resources, the National Institutes of Health, and the Rheumatology Research Foundation.


© 2018  American Academy of Dermatology, Inc. Tous droits réservés.
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Vol 79 - N° 6

P. 1053 - décembre 2018 Retour au numéro
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