Journal Article

AB1091 MORTALITY AND RISK OF END-STAGE RENAL DISEASE IN SYSTEMIC LUPUS ERYTHEMATOSUS: A RETROSPECTIVE COHORT STUDY ASSESSING TRADITIONAL CHINESE MEDICINE USERS

Yu, K. H., Wei, C. Y., Yu, H. H.

2024

Overview

Background:Systemic lupus erythematosus (SLE) frequently results in renal complications, significantly impacting both morbidity and mortality rates. Conventional drugs, including corticosteroids and disease-modifying antirheumatic drugs, while controlling disease activity, may lead to side effects and elevate the likelihood of severe infections. Consequently, many SLE patients also seek complementary therapies simultaneously, such as Traditional Chinese Medicine (TCM) [1].Objectives:This retrospective cohort study aims to evaluate end-stage renal disease (ESRD) and mortality rates among patients with SLE utilizing Traditional Chinese Medicine.Methods:We utilized multi-institutional cohort data from the Chang Gung Research Database (CGRD) between January 1, 2005, and December 31, 2020. Patients were followed until the end of 2022, occurrence of ESRD, or death. TCM users were identified as SLE patients who visited Chinese medicine clinics at least twice and received oral TCM prescriptions. Two-stage propensity score matching (PSM) was applied to create a baseline characteristics-matched (age, sex, comorbidities, conventional drugs, creatinine, C3, C4, anti-dsDNA) cohort, selecting a ratio of 1:2 for the TCM and non-TCM groups. Cox proportional hazard regression and Kaplan-Meier methods were used to assess mortality and ESRD rates.Results:PSM successfully balanced the differences between the TCM and non-TCM groups, resulting in a cohort of 5637 patients (1879 TCM users and 3758 non-TCM users). The mortality rate was 1.31 per 100 person-years for the TCM group and 2.52 for the non-TCM group. After adjusting for confounding covariates, the hazard ratio of mortality for the TCM group was 0.72 (95% CI 0.62-0.84, p<0.0001). The TCM group exhibited significantly higher survival rates (log-rank test p<0.0001; Figure 1). While ESRD rates showed no significant difference, a more stringent inclusion criterion (TCM usage ≥30 days) revealed a consistent, albeit not statistically significant, trend of reduced ESRD risk throughout the 0.5 to 4-year follow-up periods (Table 1).Conclusion:Patients with SLE using TCM demonstrated lower mortality rates, emphasizing a potential benefit of TCM in managing SLE. Additionally, a trend towards reduced ESRD risk emerged with prolonged TCM use, suggesting a possible protective effect over an extended follow-up period up to the fourth year.REFERENCES:[1] Chou CT. Alternative therapies: what role do they have in the management of lupus? Lupus. 2010 Oct;19(12):1425-9.Figure 1.The Kaplan–Meier curve for survival probability of the TCM and non-TCM groups.Table 1.End-stage renal disease risk throughout the 0.5 to 4-year follow-up periods.Follow yearNon-TCM(event/number)TCM(event/number)ESRDaHR (95% CI)p-value0.533/ 56521/ 14130.19(0.03-1.40)0.10141/ 56527/ 14130.74(0.33-1.65)0.46262/ 565213/ 14130.94(0.51-1.71)0.83383/ 565218/ 14130.97(0.58-1.62)0.904106/ 565223/ 14130.97(0.61-1.52)0.88Acknowledgements:The authors thank Po-Chuan Ko for the statistical assistance and wish to acknowledge for statistical and data analysis asistance and interpretation support by the Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou.Disclosure of Interests:None declared.

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier B.V,Elsevier Limited
• Subject: Anti-DNA antibodies / Cohort analysis / Comorbidity / Corticosteroids / Creatinine / End-stage renal disease / Interdisciplinary research / Kidney diseases / Kidneys / Lupus / Morbidity / Mortality / Real-world evidence / Scientific Abstracts / Statistical analysis / Statistics / Survival / Systemic lupus erythematosus / Traditional Chinese medicine