Increased Lupus Flare Frequency Associated With Worsened Patient Outcomes

Increased lupus flare frequency is linked to worsened patient outcomes, measured by hospitalization visits to the emergency department/urgent care, work productivity loss, and activity impairment, according to research results published in the Journal of Managed Care and Specialty Pharmacy. In addition, the researchers revealed that this association may be an important indicator of disease severity and resource burden.

Investigators conducted a cross-sectional analysis to examine the relationship between lupus flares and both direct and indirect costs associated with the flares. Investigators aimed to quantify the association between patient-reported lupus flare frequency, hospital admissions, unplanned emergency department/urgent care visits, work productivity loss, and nonwork activity impairment.

Overall, 1012 patients from the Lupus Foundation of America and 595 from a research panel completed surveys, with 939 (92.8%) and 564 (94.8%) of respondents retained after quality checks, respectively. The total sample size was 1503, with 1288 patients (85.7%; mean age, 45.2 years; 90.2% women) having a known flare frequency in the previous 12 months and with available data for hospital admissions, emergency department/ urgent care visits. A further subset of 636 survey respondents (49.4%) were evaluated to assess work-related productivity loss.

Results of the survey indicated that women were more likely to present in the higher-frequency flare groups. Mean age among flare groups varied significantly but the trend was not directional. There was a trend toward lower incomes and lower employment rates as flare frequency increased. Smoking rates and mean body mass index also increased with flare frequency. Researchers also noted that severe flare activity was also associated with increasing flare frequency.

Increasing flare frequency was significantly associated with the mean number of lupus-related hospital admissions. Investigators conducted an initial multivariable regression model and identified covariates including sex, race, age, household income, and body mass index common among those who reported 1 to 3, 4 to 6, and ≥7 flares in the previous 12 months (adjusted rate ratio increases [95% CI] of 1.72-fold, 1.97-fold, and 3.14-fold, respectively).

Mean number of lupus-related emergency department/urgent care visits was also significantly associated with increased flare frequency. Using a regression model, investigators examined the relationship between flare frequency and unplanned emergency department/urgent care visits; results showed that respondents who reported flares were 7 to 16 times more likely to have unplanned emergency department/urgent care visits (adjusted rate ratio [95% CI] for 1-3, 4-6, and ≥7 flares, 6.98, 7.35, and 16.12, respectively).

Researchers indicated an increasing flare frequency with greater nonwork activity impairment. An examination of the subsample of employed respondents (n=636) showed that absenteeism increased with lupus flare frequency. Results from a multivariable regression model examining sex and age covariates showed that survey respondents who reported 0, 1 to 3, 4 to 6, and ≥7 flares experienced an average of 28.7%, 41.4%, 54.8%, and 61.9% work productivity loss, respectively.

Study limitations included the use of self-reported diagnosis, patient recall bias in terms of reporting the number of flares, limited productivity loss measurement, and the use of a population-based survey to collect responses.

“Timely response with access to treatment options and implementation of preventive strategies may help reduce [healthcare] resource use and work productivity loss,” the researchers concluded.

Disclosure: This clinical trial was supported by Mallinckrodt Pharmaceuticals. Please see the original reference for a full list of authors’ disclosures.

Reference

Katz P, Nelson WW, Daly P, Topf L, Connolly-Strong E, Reed ML. Patient-reported lupus flare symptoms are associated with worsened patient outcomes and increased economic burden. J Manag Care Spec Pharm. 2020;26(3):275-283.