Examinando por Autor "Drenkard, C."

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  • Miniatura
    ÍtemAcceso Abierto
    Remission and Low Disease Activity Status (LDAS) protect lupus patients from damage occurrence: data from a multiethnic, multinational Latin American Lupus Cohort (GLADEL)
    (2017) Ugarte-Gil, M.F.; Wojdyla, D.; Pons-Estel, G.J.; Catoggio L.J.; Drenkard, C.; Sarano, J.; Berbotto, G.A.; Borba, E.F.; Sato, E.I.; Tavares Brenol, J.C.; Uribe, O.; Ramirez Gómez, L.A.; Guibert-Toledano, M.; Massardo, L.; Cardiel, M.H.; Silveira, L.H.; Chacón-Diaz, R.; Alarcón, G.S.; Pons-Estel, B.A.; GLADEL
    OBJECTIVE: To evaluate disease activity statuses' (DAS') impact on systemic lupus erythematosus (SLE) outcomes.MATERIALS AND METHODS: Four DAS were defined: remission off-therapy: SLE Disease Activity Index (SLEDAI)=0, no prednisone or immunosuppressive drugs (IS); remission on-therapy: SLEDAI=0, prednisone ≤5 mg/day and/or IS (maintenance); low (L) DAS: SLEDAI ≤4, prednisone ≤7.5 mg/day and/or IS (maintenance); non-optimally controlled: SLEDAI >4 and/or prednisone >7.5 mg/day and/or IS (induction). Antimalarials were allowed in all. Predefined outcomes were mortality, new damage (increase of at least one Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI) point) and severe new damage (increase of at least 3 SDI points). Univariable and multivariable Cox regression models were performed to define the impact of DAS, as time-dependent variable, on these outcomes.RESULTS: 1350 patients were included, 79 died during follow-up, 606 presented new and 177 severe new damage. In multivariable analyses, remission (on/off-therapy) was associated with a lower risk of new (HR 0.60; 95% CI 0.43 to 0.85), and of severe new damage (HR 0.32; 95% CI 0.15 to 0.68); low disease activity status (LDAS) was associated with a lower risk of new damage (HR 0.66; 95% CI 0.48 to 0.93) compared with non-optimally controlled. No significant effect on mortality was observed.CONCLUSIONS: Remission was associated with a lower risk of new and severe new damage; LDAS with a lower risk of new damage after adjusting for other damage confounders. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
  • Miniatura
    ÍtemAcceso Abierto
    The number of flares patients experience impacts on damage accrual in systemic lupus erythematosus: Data from a multiethnic Latin American cohort
    (BMJ Publishing Group, 2015) Ugarte-Gil, M.F.; Acevedo-Vásquez, E.; Alarcón, G.S.; Pastor-Asurza, C.A.; Alfaro-Lozano, J.L.; Cucho-Venegas, J.M.; Segami, M.I.; Wojdyla, D.; Soriano, E.R.; Drenkard, C.; Brenol, J.C.; De Oliveira E Silva Montandon, A.C.; Lavras Costallat, L.T.; Massardo, L.; Molina-Restrepo, J.F.; Guibert-Toledano, M.; Silveira, L.H.; Amigo, M.C.; Barile-Fabris, L.A.; Chacón-Díaz, R.; Esteva-Spinetti, M.H.; Pons-Estel, G.J.; McGwin, G. Jr.; Pons-Estel, B.A.
    Purpose: To determine the association between the number of flares systemic lupus erythematosus (SLE) patients experience and damage accrual, independently of other known risk factors. Methods: SLE patients (34 centres, nine Latin American countries) with a recent diagnosis (≤2 years) and ≥3 evaluations were studied. Disease activity was ascertained with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and damage with the SLICC/ACR Damage Index (SDI). Flare was defined as an increase ≥4 points in the SLEDAI between two study visits. An ambidirectional case- crossover design was used to determine the association between the number of flares and damage accrual. Results: 901 patients were eligible for the study; 500 of them (55.5%) experienced at least one flare, being the mean number of flares 0.9 (SD: 1.0). 574 intervals from 251 patients were included in the case-crossover design since they have case and control intervals, whereas, the remaining patients did not. Their mean age at diagnosis was 27.9 years (SD: 11.1), 213 (84.9%) were women. The mean baseline SDI and SLEDAI were 1.3 (1.3) and 13.6 (8.1), respectively. Other features were comparable to those of the entire sample. After adjusting for possible confounding variables, the number of flares, regardless of their severity, was associated with damage accrual (SDI) OR 2.05, 95% CI 1.43 to 2.94, p<0.001 (OR 2.62, 95% CI 1.31 to 5.24, p=0.006 for severe and OR 1.91, 95% CI 1.28 to 2.83, p=0.001 for mild-moderate). Conclusions: The number of flares patients experience, regardless of their severity, increases the risk of damage accrual, independently of other known risk factors. © 2015, BMJ Publishing Group. All rights reserved.