ALL-CAUSE, CARDIOVASCULAR AND MALIGNANCY RELATED MORTALITY IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE): A POPULATION-BASED STUDY

Background: SLE is associated with increased risk of overall mortality; however morality trends due to specific causes including cardiovascular disease (CVD), malignancies or other causes are largely unknown. Objectives: Our objective was to assess trends in cause-specific mortality among SLE patients between January 1, 1997 and December 31, 2012 in a general population-based context. Methods: We conducted a population-based matched cohort on SLE patients diagnosed between January 1,1997 and December 31,2012 using an administrative health database from the province of British Columbia, Canada. We identified all incident cases of SLE and up to 10 non-SLE controls matched on sex, age, and calendar year of study entry. The cohort was divided into two cohorts based on year of SLE diagnosis (1997–2004 and 2005–2012). All-cause mortality and cause-specific incidence of death rates (IR) were calculated. Cox proportional hazard regression models were used to estimate the mortality hazard ratios (HR), adjusting for possible confounders (i.e. Charlson Comorbidity Index, number of outpatient visits, hospitalization, cardiovascular medications, glucocorticoids and NSAIDs at baseline). Results: 4238 SLE and 42380 matched controls were studied. SLE patients had significantly increased all-cause mortality with HR 1.29 (95% CI, 1.15–1.46) and increased cause-specific mortality from CVD and other causes with HRs of 1.43 (95% CI, 1.15 -1.79) and 1.74 (95% CI, 1.46–2.09), respectively. The cohorts did not differ in the rate of death from malignancy. SLE patients had an approximately 2-fold increase in death from other causes in both early (HR 1.86 (95% CI 1.33–2.60)) and recent cohorts (HR 1.90 (95% CI 1.42–2.56)). There was no significant improvement in all-cause and cause-specific mortality trends between the two cohorts. Table 1. Overall and cause-specific mortality in SLE patients compared to general population; HR, hazard ratio CohortsAll-Cause DeathsCVD DeathsMalignancy DeathsOther Causes DeathsHR (95% CI)DeathsHR (95% CI)DeathsHR (95% CI)DeathsHR (95% CI) Overall CohortSLE (n=4238)4111.29 (1.15–1.46)1041.43 (1.15–1.79)950.80 (0.63–1.00)2121.74 (1.46–2.09) Non-SLE (n=42380)22261622179518091 Female CohortSLE (n=3643)3231.34 (1.17–1.54)751.40 (1.08–1.81)770.81 (0.62–1.05)1712.05 (1.68–2.50) Non-SLE (n=36430)16971469161816101 Male CohortSLE (n=595)881.06 (0.81–1.39)291.73 (1.10–2.71)180.76 (0.44–1.30)411.06 (0.70–1.62) Non-SLE (n=5950)5291153117711991 Early Cohort (1997–2004)SLE (n=1678)981.20 (0.96–1.51)251.18 (0.76–1.82)220.68 (0.42–1.09)511.86 (1.33–2.60) Non-SLE (n=16780)5081163117311721 Recent Cohort (2005–2012)SLE (n=2560)1371.13 (0.92–1.39)250.89 (0.57–1.39)330.66 (0.45–0.98)791.90 (1.42–2.56) Non-SLE (n=25600)6221179126012231 Conclusions: This study demonstrates that despite advances in therapy with novel biologic agents, there are no significant differences in all-cause and CVD mortality from SLE between early and recent cohorts. Death from other causes, which includes a composite of death related to for example renal disease and infections, remains high suggesting areas for future targeted research and therapy. Disclosure of Interest: None declared DOI: 10.1136/annrheumdis-2017-eular.4451Citation: Annals of the Rheumatic Diseases, volume 76, supplement 2, year 2017, page 68Session: SLE, Sjögren's and APS - clinical aspects (Oral Presentations )