Health-Related Quality of Life and Employment Among Persons with Systemic Lupus Erythematosus

To study the clinical characteristics and health related quality of life (HRQoL) in systemic lupus erythematosus patients.

94 adult SLE patients were included from those attending Zagazig University Hospitals. SLE disease activity index (SLEDAI) and Systemic Lupus International Collaborative Clinics damage Index (SLICC/DI) were recorded. The health-related quality of life (HRQoL) was assessed using the lupus-QoL (LQoL) questionnaire.

The mean age of the patients was 36.9 ± 14.1 years and disease duration 5.8 ± 4 years. All LqoL domains were reduced. LQoL was significantly related to the gender, SLEDAI, SLICC/DI, erythrocyte sedimentation rate (ESR), anti-nuclear antibody (ANA) and anti-double stranded deoxyribonucleic acid (ds-DNA) (p < 0.0001, p < 0.0001, p = 0.03, p = 0.002, p = 0.02, p < 0.0001 respectively). The LQoL was not related to the age, disease duration and level of education. All 8 domains significantly correlated with SLEDAI and SLICC/DI. Mucocutaneous manifestations lowered emotional health (43.3 ± 5.7), body image (45.3 ± 6.9) and fatigue (47.3 ± 9.3) domains; neuropsychiatric manifestation lowered the emotional health (43.4 ± 9.7), planning (47.3 ± 8.8) and intimate relationship (49.2 ± 11.7); musculoskeletal manifestations mainly worsened burden to others (31.3 ± 10.5), pain (47.6 ± 10.4) and physical health (50.3 ± 11.3) while lupus nephritis mainly decreased physical health (60.4 ± 11.4), fatigue (61.2 ± 5.7), burden to others (62.4 ± 11.4) and emotional health (67.4 ± 20.3).

SLE is a condition associated with high unmet need and considerable burden to patients. To our knowledge, no previous study has systematically examined the clinical features as well as HRQoL of SLE patients in Sharkia Governorate, Eastern Egypt. HRQoL is a multidimensional concept that encompasses physical, emotional and social components associated with SLE manifestations.

Similar to many other chronic illnesses, systemic lupus erythematosus (SLE) can have a major impact on physical and social functioning and work ability. The costs of care and the economic consequences of illness can be substantial. Fatigue, pain, cardiopulmonary symptoms, cognitive impairment, and neurologic deficits can cause difficulty performing activities of daily living and work tasks. These symptoms and signs, along with the psychological adjustment to illness, can affect how patients manage activities and function at home, school, and work. This chapter examines the effect of SLE on physical and social functioning, schooling, family life, and work ability as well as the costs of SLE. Because of a growing literature suggesting disparities by socioeconomic status in health care and outcomes for the disease, the chapter also summarizes recent developments in this area.

To guide management decisions for an index patient, evidence is required from comparisons between approximate matches to the profile of the index case, where some matches contain responses to treatment and others act as controls.

We describe a method for constructing clinically relevant histories/profiles using data collected but unreported from 2 recent phase 3 randomized controlled trials assessing belimumab in subjects with clinically active and serologically positive systemic lupus erythematosus. Outcome was the Systemic lupus erythematosus Responder Index (SRI) measured at 52 weeks.

Among 1175 subjects, we constructed an algorithm utilizing 11 trajectory variables including 4 biological, 2 clinical, and 5 social/behavioral. Across all biological and social/behavioral variables, the proportion of responders based on the SRI whose value indicated clinical worsening or no improvement ranged from 27.5% to 42.3%. Kappa values suggested poor agreement, indicating that each biological and patient-reported outcome provides different information than gleaned from the SRI.

The richly detailed patient profiles needed to guide decision-making in clinical practice are sharply at odds with the limited information utilized in conventional randomized controlled trial analyses.

Belimumab is an approved therapy for the treatment of systemic lupus erythematosus (SLE). This study examined the real-world utilization patterns of belimumab and standard SLE therapies in patients after regulatory approval of belimumab in the United States.

A retrospective, observational study of belimumab users in the HealthCore Integrated Research Database was conducted using administrative claims data (GlaxoSmithKline Clinical Study Register Study ID: 114955). The overall population for analysis was composed of patients who were prescribed belimumab, had ≥6 months pre- and ≥6 months post-index medical and pharmacy eligibility, and at least 1 medical claim for SLE. Patients’ clinical and demographic characteristics, treatment history, treatment patterns of belimumab, utilization of other medications, all-cause resource utilization, and costs were assessed. No hypotheses were tested.

All patients who were prescribed belimumab had an SLE claim. Patients who met all eligibility criteria (n = 155) were primarily female (94.2%; mean [SD] age, 44 [12] years) and 94.2% had used standard SLE therapies during the pre- and post-index periods. The majority had moderate SLE disease severity pre-index, and there was a small shift (approximately 8%) from moderate to mild SLE after initiation of belimumab. Two thirds of patients remained on belimumab therapy at 6 months post-index. The percentage of patients with any claim for oral corticosteroids remained stable; however, the point estimate for mean daily dose decreased slightly in months 3 to 6 post-index. Inpatient hospital admissions decreased slightly in the post-index period. The point estimate for total costs (excluding belimumab) decreased after initiation of belimumab, although overall total health care costs (including belimumab) increased.

All patients with a belimumab prescription had an SLE diagnosis on at least 1 medical claim, and the vast majority of those meeting all eligibility criteria had previously used a standard SLE therapy. Disease severity improved for a number of patients while on belimumab treatment and modest corticosteroid dose reductions were observed in later months. After initiating belimumab, health care costs (excluding belimumab) decreased. GlaxoSmithKline Clinical Study Register Study ID: 114955.