SLE AT THE TURN OF THE THIRD MILLENNIUM: HOW DISEASE MANAGEMENT HAS CHANGED IN CLINICAL PRACTICE
Notice bibliographique
Résumé
PV238 / #532 Poster Topic: AS23 - SLE-Diagnosis, Manifestations, & Outcomes Background/Purpose With the new millennium major changes have occurred in the management of lupus, these encompass the optimization of the use of old drugs, the identification of therapeutic targets such as LLDAS and remission and the introduction of new drugs such as biologics. The aim of the present study was to analyze how the new treatment paradigm impacted on the management of SLE over time in the real-life setting. Methods This is a retrospective observational study on SLE patients regularly followed at our unit and with a follow-up of at least 1 year; patients were divided in 2 groups: group 1 including patients diagnosed between 1980 and 2000 and group 2 those diagnosed after 2000. Demographic characteristics, clinical manifestations at disease onset and cumulative organ involvement, disease activity, organ damage and disease state over time and treatments received were compared. Results 428 SLE patients were included in the study, 377 females (88%), 143 patients in Group 1 (33.4%) and 285 (66.6%) in group 2. Presenting symptoms were similar between the 2 groups, while over the entire disease course we found a higher frequency of renal involvement (54% vs 40%) and neuropsychiatric involvement (17% vs 6%) in patients diagnosed before 2000. As far as therapy is concerned, almost all patients received GC during their disease course although in group 2 we found 11 patients who did never take GC (4%, p=0.02). Longitudinal analysis of the GC cumulative dose showed similar doses during the first year of the disease; however, at 5 and 10 years after diagnosis group 1 received significantly higher dosages (median 8.7 g vs 7.6 g and 15.35 g vs 14 g respectively, p<0.001 in both analyses). Interestingly, a higher percentage of patients was GC-free at 5 years from diagnosis in the group diagnosed after 2000 (29.4% vs 6.6%). 394 patients received HCQ during the disease course (93.5%), a higher proportion of patients in group 2 although not statistically different (95% vs 90%). The proportion of patients who received at least 1 IS drug within the first year of follow-up was significantly higher in patients diagnosed after 2000 (60.7% vs 39%, p<0.001) Overall, 129 patients received at least on biological drug (30%), with a significantly higher proportion in group 2 (34% vs 22%, p=0.01). In group 2, 22 (8%) patients received a biological treatment within the first year since diagnosis. At 1 year from diagnosis remission resulted more frequently achieved in patients diagnosed after 2000 (57% vs 46% respectively, p=0.03). Overall 9.7% of patients developed at least 1 item of the SLICC/DI within the first year from diagnosis (median SDI=1, range 1-3); 17.7% within 5 years (median SDI= 1, range 1-5) and 32.6% within 10 years (median SDI=1, range 1-6). The median damage score over time was similarly very low in both groups. The occurrence of renal damage (RD), cardiovascular events (CVE) and osteoporotic fractures did not show statistically significant differences between the 2 groups. Conclusions The study highlights how the clinical management of SLE patients has changed in recent years by incorporating the new treatment paradigm based on the early use of immunosuppressive drugs and steroid-sparing strategies, resulting in more effective disease control.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,011 | 0,024 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,003 |
| Communication savante | 0,005 | 0,004 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».