TOPLINE

Adults with childhood-onset systemic lupus erythematosus (SLE) experienced persistently higher disease activity well into adulthood compared with those with adult-onset SLE, despite similar rates of damage accrual during follow-up.

METHODOLOGY

• Researchers conducted a retrospective cohort study using data from the Australian Lupus Registry and Biobank, comparing 68 adults with childhood-onset SLE (diagnosed before age 18 years) with 451 adults with adult-onset SLE.
• Patients from 9 active sites in Australia were included, all over 18 years old at enrollment, with a median follow-up duration of 4.8 years.
• Patients with childhood-onset SLE were younger at enrollment (median age, 25 years) compared with patients with adult-onset SLE (median age, 41 years), but had significantly longer disease duration (median 13.2 years vs 4.2 years).
• Disease activity over time was assessed using time-adjusted mean SLE Disease Activity Index (SLEDAI) score with the area under the curve of SLEDAI-2000 (SLEDAI-2K) score.
• Percentage of time in Lupus Low Disease Activity State (LLDAS), High Disease Activity Status, flare rates, damage accrual measured by SLE Damage Index, and treatment patterns were also assessed.

TAKEAWAY

• Median time-adjusted mean SLEDAI-2K score was significantly higher in the childhood-onset SLE group compared with the adult-onset SLE group (5.0 vs 3.6; P < .001).
• Patients with childhood-onset SLE spent a median of 34.7% of their follow-up time in LLDAS compared with 50.2% for patients with adult-onset SLE (P = .003).
• At enrollment, a significantly higher proportion of patients with childhood-onset SLE had renal involvement (61.8% vs 37.3%; P < .001).
• Despite higher disease activity, new damage accrual rates during follow-up were similar between groups (26.5% in childhood-onset vs 35.7% in adult-onset SLE groups), though more than half (52.9%) of patients with childhood-onset SLE already had damage present at enrollment compared with 40.4% of patients with adult-onset SLE.

IN PRACTICE

"[The study] findings suggest earlier recognition, consistent monitoring and timely escalation of therapy during the earlier years of disease can meaningfully alter long-term outcomes. Sustained implementation of treat-to-target strategies and optimised transitional care may further reduce the burden of cumulative damage in this high-risk population," the authors of the study wrote.

SOURCE

The study was led by Rachel Koelmeyer, Centre for Inflammatory Diseases, Monash University in Clayton, Victoria, Australia. It was published online on August 5 in Lupus Science & Medicine.

LIMITATIONS

The rarity of childhood-onset SLE limited statistical power for analyzing less common disease manifestations, which may reduce precision of subgroup analyses. Race and ethnicity data were captured using broad registry categories. Most participants were recruited through tertiary public hospitals, potentially under-representing patients with milder disease or those receiving private care, which may limit generalizability to the broader SLE population.

DISCLOSURES

The study was supported by the Nancy E Pendergast Charitable Fund. Multiple authors reported receiving research grants, consulting fees, or honoraria and having other ties with pharmaceutical companies including AstraZeneca, GSK, Janssen, Bristol Myers Squibb, and others. One author reported having 5 pending patents.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.