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Few meet major clinical response criteria after treatment escalation for lupus

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Few meet major clinical response criteria after treatment escalation for lupus

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For patients with systemic lupus erythematosus (SLE), fewer than one-quarter meet criteria for major clinical response (MCR) after treatment escalation, with Black patients less likely to meet MCR criteria than white patients, according to a study published online Nov. 2 in The Lancet Rheumatology.

Sarah Dyball, Ph.D., from the University of Manchester in the United Kingdom, and colleagues conducted a longitudinal cohort study to examine the effect of ethnicity on clinical outcomes following treatment escalation. Patients aged 16 years and older with active moderate-to-severe SLE, who had initiated rituximab or belimumab within the past 12 months or standard immunosuppressive therapy within the past one month, were recruited from 64 U.K. secondary and tertiary rheumatology and nephrology centers.

The study included 422 patients: 58%, 18%, 17%, 5% and 3% were white, South Asian, Black, East Asian and of mixed or other ethnicities, respectively. The researchers found that Black patients had higher baseline disease activity, greater organ damage and more comorbidities at baseline.

Overall, 23% of patients had met MCR criteria at 12 months, including 42%, 30%, 24%, 10% and 9% of East Asian, South Asian, white and Black patients, and those of mixed or other ethnicities, respectively. Compared with white patients, patients of Black ethnicity had lower odds of meeting MCR criteria in the adjusted five-group model (odds ratio, 0.13).

"These findings highlight the need for coordinated strategies to address the biological, structural and social determinants underpinning inequitable outcome," the authors write.


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