Call to Action: Future Innovations Should Focus on Early Diagnosis and Treatment in SLE

Early diagnosis and treatment are the greatest challenges in reducing costs and improving health care outcomes among patients with systemic lupus erythematosus (SLE), according to an editorial published in Rheumatology Advances & Practices.

Previous studies have reported long delays between symptom-onset and diagnosis in SLE, leading to high mortality in the first year of diagnosis. As the disease progresses, patients experience long-term complications and decreased quality of life. However, the economic burden of SLE over the course of the disease is not well understood.

The authors reviewed several previously published studies that examined health care utilization data for adults with SLE. The studies indicated the following:

• Health care utilization and costs increased incrementally in the 3 to 5 years prior to diagnosis. One study found that costs peaked the year of diagnosis, remained high, then increased again in years 8 through 10.
• Health care costs in patients with severe SLE were higher than patients with mild or moderate disease (4.7- and 1.6-fold, respectively).
• The mean delay in medication initiation after diagnosis was 177 days, resulting in flare episodes.

The authors noted that there is a critical need for a different approach to referral, diagnosis, and early treatment to improve outcomes and prevent irreversible damage, with strategies such as better diagnostics during the preclinical and early phases of SLE. The European Alliance of the Associations for Rheumatology (EULAR) guidelines have recommended that patients with rheumatoid arthritis (RA) are referred to and seen by a rheumatologist within 6 weeks of the onset of symptoms. The authors of the editorial said that similar guidelines were needed for patients with suspected SLE.

Limitations of the studies reviewed included the potential for miscoding and misclassification (especially for patients with mild SLE) and both the underestimation and overestimation of disease severity. The studies also did not include age- and sex-matched healthy control participants and did not consider ancestry and ethnicity.

“Future treatment innovations in SLE should focus on early diagnosis and treatment,” the authors concluded. “New clinical trial designs will be required when the objective is the prevention of severe disease rather than response. Finally, a full health economic analysis would confer whether such a strategy is cost-effective enough from the perspective of the funders/taxpayers.”

Disclosure: Both study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Yusof MYM, Vital EM. Early intervention in systemic lupus erythematosus: time for action to improve outcomes and healthcare utilization. Rheumatol Adv Pract. Published online December 28, 2021. doi:10.1093/rap/rkab106