SEX DIFFERENCES IN SYSTEMIC LUPUS ERYTHEMATOSUS: A COMPREHENSIVE ANALYSIS OF CLINICAL AND TREATMENT DISPARATIES IN A MULTICENTER LONGITUDINAL COHORT

PV190 / #379 Poster Topic: AS22 - SLE Heterogeneity Background/Purpose Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with female predominance. Due to its lower prevalence in men, SLE is less well understood in male patients. This study aimed to examine disparities in clinical manifestations, treatment, and outcomes between female and male patients with SLE using data from a multicenter longitudinal cohort. Methods Prospectively collected data from a 13-country cohort were analyzed. Demographics, fulfillment of 1997 American College of Rheumatology (ACR) classification criteria, disease activity (SLEDAI-2K, flare), medications, lupus low disease activity state (LLDAS) and DORIS remission attainment, and SLICC/ ACR damage index (SDI) were compared between female and male patients using Chi-squared tests (categorical variables) and Kruskal-Wallis (continuous variables) tests. Results A total of 4,106 SLE patients were studied. 328 (8.0%) were male, who were more likely to be non-Asian (14.5% vs 10.8%, p=0.04), active smoker (22.3% vs 3.9%, p<0.01), have shorter disease duration (7.0 years vs 8.0 years, p=0.01), and live in countries with a high gross domestic product (GDP ≥ $50,000 per capita) (58.5% vs 48.2%, p<0.01) (Table 1). At study enrollment, disease activity (SLEDAI-2K 4.0 vs 4.0, p=0.86) was similar between male and female patients, while female patients had more frequent use of anti-malarials (78.7% vs 72.0%, p=0.01), mycophenolate mofetil (32.0% vs 22.6%, p<0.01), and cyclophosphamide (6.7% vs 4.1%, p=0.03) Organ damage (defined as SDI>0) was present in 43% of males and 37% of females (p=0.07) at study enrollment with more frequent damage in peripheral vascular domain observed in male patients (6.0% vs 2.7%, p<0.01). Over a follow-up duration of 2.5 (IQR 1.0-5.1) years, male patients were more likely to receive anti-malarial (86.3% vs 78.2%, p<0.01) and mycophenolate mofetil (43.0% vs 36.7%, p=0.03), but less likely to experience flares (46.6% vs 53.7%, p=0.02). The frequency of organ damage accrual (defined as increase in SDI≥1) and treat-to-target state attainment was similar between male and female patients (Table 1). Over 42,347 clinical visits, clinical disease activity (defined as clinical SLEDAI-2K>0) was observed in 16,804 (39.7%) visits (Figure 1). Male patients had more visits with active disease in renal domain (29.2% vs 22.3%, p<0.01), including patients without renal involvement at baseline (17.4% vs 10.1%, p<0.01). Visits with active disease in mucocutaneous domain (12.5% vs 11.3%, p=0.03) and vasculitis (0.9% vs 0.6%, p=0.04) were also more frequent among male patients. In contrast, female patients had more visits with activity in musculoskeletal (3.1% vs 4.5%, p<0.01) and hematological domain s(5.2% vs 6.3%, p=0.02). LLDAS was attained in 19441 (45.9%) visits overall. In clinical visits not in LLDAS, Pred >7.5 mg/D (51.7% vs 48.0%, p<0.01) and SLEDAI>4 (53.0% vs 49.4%, p<0.01) occurred more frequently among male patients. Renal activity was observed in over half (52.6% vs 44.2%, p<0.01) of non-LLDAS visits in male patients. Table 1: Clinical characteristics of the study cohort Figure 1: Disease activity by SLEDAI organ domains in 42,347 visits Conclusions Renal activity is more frequent in male patients with SLE, with males having more frequent clinical visits for active renal disease compared to females. Further studies are required to understand the mechanisms behind the differences between male and female SLE patients.

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