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Neuropsychiatric events in systemic lupus erythematosus : A longitudinal analysis of outcomes in an international inception cohort using a multistate model approach

Hanly, John G. ; Urowitz, Murray B. ; Gordon, Caroline ; Bae, Sang Cheol ; Romero-Diaz, Juanita ; Sanchez-Guerrero, Jorge ; Bernatsky, Sasha ; Clarke, Ann E. ; Wallace, Daniel J. and Isenberg, David A. , et al. (2020) In Annals of the Rheumatic Diseases 79(3). p.356-362
Abstract

Objectives: Using a reversible multistate model, we prospectively examined neuropsychiatric (NP) events for attribution, outcome and association with health-related quality of life (HRQoL), in an international, inception cohort of systemic lupus erythematosus (SLE) patients. Methods: Annual assessments for 19 NP events attributed to SLE and non-SLE causes, physician determination of outcome and patient HRQoL (short-form (SF)-36 scores) were measured. Time-to-event analysis and multistate modelling examined the onset, recurrence and transition between NP states. Results: NP events occurred in 955/1827 (52.3%) patients and 592/1910 (31.0%) unique events were attributed to SLE. In the first 2 years of follow-up the relative risk (95% CI)... (More)

Objectives: Using a reversible multistate model, we prospectively examined neuropsychiatric (NP) events for attribution, outcome and association with health-related quality of life (HRQoL), in an international, inception cohort of systemic lupus erythematosus (SLE) patients. Methods: Annual assessments for 19 NP events attributed to SLE and non-SLE causes, physician determination of outcome and patient HRQoL (short-form (SF)-36 scores) were measured. Time-to-event analysis and multistate modelling examined the onset, recurrence and transition between NP states. Results: NP events occurred in 955/1827 (52.3%) patients and 592/1910 (31.0%) unique events were attributed to SLE. In the first 2 years of follow-up the relative risk (95% CI) for SLE NP events was 6.16 (4.96, 7.66) and non-SLE events was 4.66 (4.01, 5.43) compared with thereafter. Patients without SLE NP events at initial assessment had a 74% probability of being event free at 10 years. For non-SLE NP events the estimate was 48%. The majority of NP events resolved over 10 years but mortality was higher in patients with NP events attributed to SLE (16%) versus patients with no NPSLE events (6%) while the rate was comparable in patients with non-SLE NP events (7%) compared with patients with no non-SLE events (6%). Patients with NP events had lower SF-36 summary scores compared with those without NP events and resolved NP states (p<0.001). Conclusions: NP events occur most frequently around the diagnosis of SLE. Although the majority of events resolve they are associated with reduced HRQoL and excess mortality. Multistate modelling is well suited for the assessment of NP events in SLE.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
autoimmune diseases, epidemiology, outcomes research, systemic lupus erythematosus
in
Annals of the Rheumatic Diseases
volume
79
issue
3
pages
7 pages
publisher
BMJ Publishing Group
external identifiers
  • pmid:31915121
  • scopus:85077755832
ISSN
0003-4967
DOI
10.1136/annrheumdis-2019-216150
language
English
LU publication?
yes
id
34f6bb79-8da8-4cd8-b260-a7d48bce09c3
date added to LUP
2020-01-23 12:34:08
date last changed
2022-08-11 03:25:48
@article{34f6bb79-8da8-4cd8-b260-a7d48bce09c3,
  abstract     = {{<p>Objectives: Using a reversible multistate model, we prospectively examined neuropsychiatric (NP) events for attribution, outcome and association with health-related quality of life (HRQoL), in an international, inception cohort of systemic lupus erythematosus (SLE) patients. Methods: Annual assessments for 19 NP events attributed to SLE and non-SLE causes, physician determination of outcome and patient HRQoL (short-form (SF)-36 scores) were measured. Time-to-event analysis and multistate modelling examined the onset, recurrence and transition between NP states. Results: NP events occurred in 955/1827 (52.3%) patients and 592/1910 (31.0%) unique events were attributed to SLE. In the first 2 years of follow-up the relative risk (95% CI) for SLE NP events was 6.16 (4.96, 7.66) and non-SLE events was 4.66 (4.01, 5.43) compared with thereafter. Patients without SLE NP events at initial assessment had a 74% probability of being event free at 10 years. For non-SLE NP events the estimate was 48%. The majority of NP events resolved over 10 years but mortality was higher in patients with NP events attributed to SLE (16%) versus patients with no NPSLE events (6%) while the rate was comparable in patients with non-SLE NP events (7%) compared with patients with no non-SLE events (6%). Patients with NP events had lower SF-36 summary scores compared with those without NP events and resolved NP states (p&lt;0.001). Conclusions: NP events occur most frequently around the diagnosis of SLE. Although the majority of events resolve they are associated with reduced HRQoL and excess mortality. Multistate modelling is well suited for the assessment of NP events in SLE.</p>}},
  author       = {{Hanly, John G. and Urowitz, Murray B. and Gordon, Caroline and Bae, Sang Cheol and Romero-Diaz, Juanita and Sanchez-Guerrero, Jorge and Bernatsky, Sasha and Clarke, Ann E. and Wallace, Daniel J. and Isenberg, David A. and Rahman, Anisur and Merrill, Joan T. and Fortin, Paul R. and Gladman, Dafna D. and Bruce, Ian N. and Petri, Michelle and Ginzler, Ellen M. and Dooley, Mary Anne and Ramsey-Goldman, Rosalind and Manzi, Susan and Jönsen, Andreas and Alarcón, Graciela S. and Van Vollenhoven, Ronald F. and Aranow, Cynthia and MacKay, Meggan and Ruiz-Irastorza, Guillermo and Lim, Sam and Inanc, Murat and Kalunian, Kenneth C. and Jacobsen, Søren and Peschken, Christine A. and Kamen, Diane L. and Askanase, Anca and Farewell, Vernon}},
  issn         = {{0003-4967}},
  keywords     = {{autoimmune diseases; epidemiology; outcomes research; systemic lupus erythematosus}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{356--362}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{Annals of the Rheumatic Diseases}},
  title        = {{Neuropsychiatric events in systemic lupus erythematosus : A longitudinal analysis of outcomes in an international inception cohort using a multistate model approach}},
  url          = {{http://dx.doi.org/10.1136/annrheumdis-2019-216150}},
  doi          = {{10.1136/annrheumdis-2019-216150}},
  volume       = {{79}},
  year         = {{2020}},
}