POLYPHARMACY AMONG PEOPLE LIVING WITH SYSTEMIC LUPUS ERYTHEMATOSUS

PV054 / #546

Poster Topic: AS06 - Comorbidities

Background/Purpose Polypharmacy is known to be associated with adverse health outcomes in the general population. Recent studies have reported high rates of polypharmacy among people living with systemic lupus erythematosus (SLE). However, the relationship between polypharmacy and health outcomes in SLE remains unknown. This study aimed to 1) Identify demographic and clinical characteristics associated with polypharmacy; and 2) Determine the association between baseline polypharmacy and subsequent risk of mortality among people living with SLE.

Methods This was a secondary analysis of data from a prospective observational cohort of adults with SLE followed at a single academic medical center between 2000 and 2021. All participants met the 1997 revised American College of Rheumatology (ACR) classification criteria for SLE and were assessed annually for medication use, disease activity (measured using the Systemic Lupus Erythematosus Disease Activity Index 2000 [SLEDAI-2K]), organ damage (measured using the SLICC/ACR Damage Index [SDI]), and other measures. The baseline visit for this analysis was defined as the first study visit for each patient at which data were available for all relevant variables. Polypharmacy was defined as the concurrent exposure to 5 or more medications at the baseline visit. Mortality was defined as any recorded death within the follow-up period. Chi-square tests and Wilcoxon rank-sum tests were used to assess the difference in baseline characteristics between those with vs without baseline polypharmacy. Cox proportional hazards regression was used to evaluate the association between baseline polypharmacy and subsequent mortality risk during follow-up. The multivariable model was adjusted for potential confounders, including baseline age, baseline SDI score, and baseline corticosteroid use.

Results The 226 included patients (89.4% female) had a median (IQR) age of 45 (34-54) years and a median (IQR) disease duration of 10.0 (2.3-15.6) years at baseline. Polypharmacy was present in 134 patients (59.3%) at baseline. At baseline, polypharmacy was associated with increased age, higher SDI scores, corticosteroid use, immunosuppressive use, and frailty (Table 1). The Kaplan-Meier curves for mortality risk by baseline polypharmacy status are shown in (Figure 1). There was a significant association between baseline polypharmacy and mortality risk during follow-up in the unadjusted analysis (hazard ratio [HR] 4.16, 95% CI 1.93-8.97). After adjusting for baseline age, SDI score, and corticosteroid use, the association was no longer statistically significant (HR 2.02, 95% CI 0.87-4.71, p=0.10).

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Figure 1.

Kaplan-Meier survival curves for mortality risk during follow-up among SLE patients with baseline polypharmacy (in red) versus without baseline polypharmacy (in blue).

Conclusions Among people living with SLE, baseline polypharmacy was associated with increased risk of mortality during follow-up, but these results were no longer statistically significant after accounting for potential confounders. Future research will aim to understand the association of polypharmacy with other health outcomes (eg, organ damage accrual), as well as the trajectories of polypharmacy and high-risk medication use over time in people living with SLE.