Clinical and Demographic Features of Patients With Moderate to Severe Active Systemic Lupus Erythematosus in Russia

AstraZeneca637 enrolled

Overview

This is a multicenter observational retrospective-prospective study consisting of retrospective and prospective phases. Trial will include 2 visits for obtaining the patient's demographic and clinical data: the 1st is retrospective and the 2nd is prospective. The study will involve approximately 50 sites of the Russian Federation; in each site about 20 patients will be recruited. The total planned size of study population will be approximately 1000 patients enrolled to the retrospective phase of the study, from which \~ 600 patients will be enrolled to the prospective phase.

Systemic lupus erythematosus (SLE) is a systemic autoimmune rheumatic disease with variable clinical manifestations and an unpredictable course, affecting any organs or systems, which quite often develops over several months or years, with persistent or, conversely, rapidly changing clinical manifestations, an undulating course, alternating remissions and flares. Currently, in Russia there is no exact data on the number of patients with active moderate to severe SLE in the population, since there is no unified system for regular monitoring of patients with SLE in the country. The systematic information about complications and comorbidities, about the treatment approaches and their effectiveness in the Russian population is also absent. The Russian Federation consists of 85 regions with a total population of more than 145 million people. The regions differ in ethnic composition, age, gender, climate, ecology, economic level, prevalence of SLE in general and moderate to severe SLE in particular. Thus, there is a need to perform a large-scale observational study in regions of the country with a sufficient size of population to obtain information on moderate to severe SLE epidemiology, clinical and demographic characteristics, to describe main clinical outcomes and evaluate existing associations between observed treatment patterns and clinical outcomes in real clinical practice. Trial will include 2 visits for obtaining the patient's demographic and clinical data: the 1st is retrospective and the 2nd is prospective. To allow wide data coverage the study will involve approximately 50 sites of Russian Federation; in each site about 20 patients will be recruited. Overall expected duration of the study (from the first patient inclusion to the last patient last visit) is about 13 months or until 1000 patients will be included in the retrospective phase and \~ 600 patients - in the prospective phase This observational study does not imply any intervention into a routine clinical practice, including choice of treatment modality or special methods of investigation.

Study Type

Eligibility

Sex: ALL

Medical Language ↔ Plain English

Inclusion Criteria: Inclusion criteria for the retrospective phase are: 1. Patients with the diagnosis of SLE (ICD code: M32) confirmed by medical records; 2. Patients with availability of data of at least one visit to the clinic in the medical records in the last 24 months prior to inclusion; 3. Age ≥ 18 years at the time of last patient's visit to the clinic. Additional inclusion criteria for the prospective phase are: 4. Signed and dated written informed consent in accordance with ICH-GCP and local law prior to inclusion in the prospective phase of the study; 5. Disease activity measured with SLEDAI-2K ≥ 6 despite of standard treatment at the time of inclusion in the prospective phase of the study Exclusion Criteria: Exclusion criteria for the retrospective phase are: 1. Regular use of genetically engineered biological drugs for SLE treatment within the last 24 months prior to inclusion; 2. Participation in any interventional trial since the last patient's visit to the clinic; 3. Presence of lupus nephritis class III/IV ± V at the moment of the last patient's visit to the clinic; 4. Presence of neuropsychiatric lupus at the moment of the last patient's visit to the clinic. Additional exclusion criteria for the prospective phase are: 5. Current use of genetically engineered biological drugs for SLE treatment; 6. Current participation in any interventional trial; 7. Presence of lupus nephritis Class III/IV ± V at the moment of patient's visit; 8. Presence of neuropsychiatric lupus at the moment of patient's visit; 9. An acute or chronic disease that, in the opinion of the investigator, limits the ability of patient to provide data on his/her health or participate in this study or influence the interpretation of the results.

Locations (32)

Research Site

Barnaul, Russia

Research Site

Belgorod, Russia

Research Site

Chelyabinsk, Russia

Research Site

Grozny, Russia

Research Site

Irkutsk, Russia

Research Site

Izhevsk, Russia

Research Site

Kaliningrad, Russia

Research Site

Kazan', Russia

Research Site

Kemerovo, Russia

Research Site

Krasnodar, Russia

...and 22 more locations

Outcomes

Primary Outcomes

disease activity status at the time of patient visit to the doctor measured with SLEDAI-2K, expressed as the mean SLEDAI-2K total score at Visit 2.

In order to achieve primary objective, the mean SLEDAI-2K total score at Visit 2 will be calculated among patients with moderate to severe SLE (i.e. SLEDAI-2K total score ≥6 measured on the Visit 2) who provided informed consent and were enrolled to the prospective phase. The Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) is a clinical index for the measurement of disease activity in SLE. The modified index SLEDAI-2K was introduced and validated in 2002; it allows the documentation of persistent activity disease in rash, mucous membrane ulcers, alopecia, and proteinuria. 4 activity categories have been defined on the basis of the SLEDAI-2K total score (higher scores indicate more damage): no activity (0 points); low activity (1-4 points); moderate activity (5-10 points), and high activity (\>10 points).

Time frame: patient's visit to the doctor (Visit 2 -prospective data collection)

Secondary Outcomes

1. Mean age at the inclusion into the study

Time frame: inclusion into the study

2. Proportion of patients aged 18-44, 45-64, and ≥65 years at the inclusion into the study

Time frame: inclusion into the study

3. Mean age at the SLE diagnosis

Time frame: within 24 months prior to inclusion into the study

4. Mean and median SLE duration, years

Time frame: from the SLE diagnosis to the Visit 1

5. Proportion of men and women

Time frame: inclusion of a patient into retrospective part of the study (Visit 1)

6. Proportion of patients from each residential region of Russia

Time frame: inclusion of a patient into retrospective part of the study (Visit 1)

7. Mean SLEDAI-2K activity total score at Visit 1 (if available)

The Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) is a clinical index for the measurement of disease activity in SLE. The modified index SLEDAI-2K was introduced and validated in 2002; it allows the documentation of persistent activity disease in rash, mucous membrane ulcers, alopecia, and proteinuria. 4 activity categories have been defined on the basis of the SLEDAI-2K total score (higher scores indicate more damage): no activity (0 points); low activity (1-4 points); moderate activity (5-10 points), and high activity (\>10 points).

Time frame: inclusion of a patient into retrospective part of the study (Visit 1)

8. The proportion of patients with each SLE activity category based on SLEDAI-2K total score at Visit 1 (if available):

* No activity (total score 0); * Low (total score 1-4); * Moderate (total score 5-10); * High (total score \>10); The Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) is a clinical index for the measurement of disease activity in SLE. The modified index SLEDAI-2K was introduced and validated in 2002; it allows the documentation of persistent activity disease in rash, mucous membrane ulcers, alopecia, and proteinuria. 4 activity categories have been defined on the basis of the SLEDAI-2K total score (higher scores indicate more damage): no activity (0 points); low activity (1-4 points); moderate activity (5-10 points), and high activity (\>10 points).

Time frame: inclusion of a patient into retrospective part of the study (Visit 1)

9. The proportion of patients with each SLE activity category based on SLEDAI-2K total score at Visit 2:

* Moderate (total score 5-10); * High (total score \>10). The Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) is a clinical index for the measurement of disease activity in SLE. The modified index SLEDAI-2K was introduced and validated in 2002; it allows the documentation of persistent activity disease in rash, mucous membrane ulcers, alopecia, and proteinuria. 4 activity categories have been defined on the basis of the SLEDAI-2K total score (higher scores indicate more damage): no activity (0 points); low activity (1-4 points); moderate activity (5-10 points), and high activity (\>10 points).

Time frame: patient's visit to the doctor (prospective part of the study)

10. Mean SLICC/ACR damage index score by each domain and total score at Visit 2

The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR damage index or SDI) is a 42-item questionnaire concerning long-term damage due to SLE in 12 organ systems for use in clinical research studies \[14, 15\]. The global score (range from 0 to 49, with higher scores indicating more damage) is the sum of the scores for all 12 organ systems.

Time frame: patient's visit to the doctor (Visit 2 -prospective data collection)

11. The proportion of patients with various organ domain involvement:

1. Skin and mucosa involvement; 2. Joints involvement; 3. Hematological disorders; 4. Immunological activity; 5. Renal involvement; 6. Serositis (pleurisy, pericarditis etc.).

Time frame: Retrospective and prospective data collection (Visit 1, Visit 2)

12. The proportion of patients with various comorbidities and concomitant treatment

Time frame: patient's visit to the doctor (Visit 2 -prospective data collection)

13. The proportion of patients with various groups of SLE treatment medications in anamnesis (at Visit 1)

Time frame: inclusion of a patient into retrospective part of the study (Visit 1)

14. The proportion of patients taking various groups and drugs of SLE treatment medications (at Visit 2);

Time frame: patient's visit to the doctor (Visit 2 -prospective data collection)

15. The mean (median) of oral glucocorticosteroids (OGCS) daily dose,

mg/day (prednisolone equivalent) (evaluated in patients who are taking OGCS);

Time frame: Retrospective and prospective data collection (Visit 1, Visit 2)

16. The proportion of patients received OGCS daily dose (prednisolone equivalent) more than 5 mg/day;

Time frame: Retrospective and prospective data collection (Visit 1, Visit 2)

17. Proportion of patient receiving immunosuppressive agents (azathioprine, cyclophosphamide, methotrexate, mycophenolate mofetil, cyclosporine, calcineurin inhibitors etc.) as a single agent or combination

Time frame: Retrospective and prospective data collection (Visit 1, Visit 2)

18. The mean value of immunological laboratory parameters

C3, C4, anti-dsDNA, ANA

Time frame: Visit 2 (within around a year from inclusion into the study)

19. The mean value of hematology laboratory parameters

leukocytes, platelets

Time frame: patient's visit to the doctor (Visit 2 -prospective data collection)

20. The proportion of patients with leukopenia <4,000/mm³;

Time frame: patient's visit to the doctor (Visit 2 -prospective data collection)

21. The proportion of patients with thrombocytopenia <100,000/mm³.

Time frame: patient's visit to the doctor (Visit 2 -prospective data collection)

Clinical and Demographic Features of Patients With Moderate to Severe Active Systemic Lupus Erythematosus in Russia

Overview

Conditions

Eligibility

Locations (32)

Outcomes

Primary Outcomes

Secondary Outcomes