Different Drugs Affect SLE Quality of Life Differently, Study Finds

A new study shows different medications for systemic lupus erythematosus (SLE) have different effects on patients’ quality of life (QOL)and underscored how patient perceptions sometimes differ from physician assessments of disease activity.

The report was published in International Journal of Rheumatic Diseases.

QOL has always been an important metric when treating patients with SLE, but the study investigators said until about 20 years ago, there were not many good measures of QOL that worked for patients with SLE.

As shown in this new report, they wanted to see what the clinical utility of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) might be in patients with SLE and to understand whether QOL tools might elucidate differences in terms of how patients benefit from medication. The authors noted that the SF-36 has been widely used in SLE studies, and they added that multiple instruments can be effective in SLE—even if they were not designed specifically for patients with the condition.

The authors identified 193 patients who had experienced 259 drug initiations, and they assessed patient QOL using the SF-36 and the SLE-specific SLEQOL scale.

They found a mix of results, depending on the scale used and the medication initiated. Patients starting intravenous cyclophosphamide had statistically significant improvement in overall QOL scores on the SLEQOL, as well as in the domains of physical functioning, activities, and self-image. People starting mycophenolate (CellCept) had improvements in total score and in the treatment, mood, and self-image domains. Finally, patients beginning therapy with azathioprine (Imuran) reported improvement in their total scores and in the activities and moods domains. However, people taking cyclosporin A and hydroxychloroquine did not have statistically significant improvements in their QOL, according to the scale.

It was not a surprise to see that different medications had different impacts on QOL, the researchers wrote. “That medications have varying effects on different components of QOL is not commonly reported but is of obvious benefit in clinical trials,” they said.

The SF-36 tool found fewer QOL effects, showing only improvements in the general health and physical functioning subscales for people receiving intravenous cyclophosphamide.

The study authors said there is likely a biological reason for the differences in QOL improvement. For instance, they noted cyclophosphamide and mycophenolate are both used in severe cases of SLE, with similar efficacy and adverse effects, making it no surprise they would affect the same domains on the SLEQOL scale.

“Although hydroxychloroquine is used in the prevention of complications and maintenance of remission, benefits are not directly perceived by the patient,” they wrote.

The investigators also noted that the improvements identified in their study tracked more closely with patient global activity assessments than with changes in the SLE Disease Activity Index scores, “affirming that the patient's perception differs from the physician's viewpoint.” However, they added that in both cases, the correlations were weak.

They concluded their study adds meaningfully to the scientific community’s understanding of how different drugs affect QOL; it also demonstrates that the SLEQOL tool is more sensitive than the SF-36, they said.

Reference

Leong KP, Tan JC-W, Thong BYH, et al. Medications impact different aspects of the quality of life of patients with systemic lupus erythematosus. Int J Rheum Dis. 2022. doi:10.1111/1756-185x.14446