TY - JOUR
T1 - Neuropsychiatric events in systemic lupus erythematosus
T2 - A longitudinal analysis of outcomes in an international inception cohort using a multistate model approach
AU - Hanly, John G.
AU - Urowitz, Murray B.
AU - Gordon, Caroline
AU - Bae, Sang Cheol
AU - Romero-Diaz, Juanita
AU - Sanchez-Guerrero, Jorge
AU - Bernatsky, Sasha
AU - Clarke, Ann E.
AU - Wallace, Daniel J.
AU - Isenberg, David A.
AU - Rahman, Anisur
AU - Merrill, Joan T.
AU - Fortin, Paul R.
AU - Gladman, Dafna D.
AU - Bruce, Ian N.
AU - Petri, Michelle
AU - Ginzler, Ellen M.
AU - Dooley, Mary Anne
AU - Ramsey-Goldman, Rosalind
AU - Manzi, Susan
AU - Jönsen, Andreas
AU - Alarcón, Graciela S.
AU - Van Vollenhoven, Ronald F.
AU - Aranow, Cynthia
AU - MacKay, Meggan
AU - Ruiz-Irastorza, Guillermo
AU - Lim, Sam
AU - Inanc, Murat
AU - Kalunian, Kenneth C.
AU - Jacobsen, Søren
AU - Peschken, Christine A.
AU - Kamen, Diane L.
AU - Askanase, Anca
AU - Farewell, Vernon
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2019
Y1 - 2019
N2 - 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.
AB - 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.
KW - autoimmune diseases
KW - epidemiology
KW - outcomes research
KW - systemic lupus erythematosus
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U2 - 10.1136/annrheumdis-2019-216150
DO - 10.1136/annrheumdis-2019-216150
M3 - Article
C2 - 31915121
AN - SCOPUS:85077755832
SN - 0003-4967
JO - Annals of the rheumatic diseases
JF - Annals of the rheumatic diseases
ER -