1456: Latin-American Systemic Lupus Erythematosus Clusters

Rosana Quintana¹, Romina Nieto², Marina Scolnik³, Nidia Meras⁴, Cintia Otaduy⁵, María Emilia Sattler⁶, Luciana González Lucero⁷, Nicolas Perez⁸, Ana Silva⁹, Odirlei Monticielo¹⁰, Angela Luzia B Duarte¹¹, Edgard Reis Neto¹², Milena Mimica¹³, Gustavo Aroca Martinez¹⁴, Gerardo Quintana-Lopez¹⁵, Mario Moreno Alvarez¹⁶, Miguel Angel Saavedra Salinas¹⁷, Margarita Portela¹⁸, Luis H Silveira¹⁹, Ignacio García Valladares²⁰, Carlos Abud-Mendoza²¹, Jorge Esquivel-Valerio²², Maria Duarte²³, Roberto Muñoz Louis²⁴, Vicente Juárez²⁵, Eduardo Ferreira Borba Neto²⁶, Luis Catoggio²⁷, Graciela Alarcón²⁸, Jose Puerta²⁹, Guillermina Harvey³⁰, Elisa Novati³¹, Valeria Arturi³², Wilfredo Grageda³³, Cecilia Pisoni³⁴, Francinne Machado Riobeiro³⁵, Emily Figueiredo Neves Yuki²⁶, Iris Guerra Herrera³⁶, Gabriel Tobón³⁷, Andres Cadena Bonfanti¹⁴, Hilda Fragoso-Loyo³⁸, Marie Teresa de Martinez³⁹, Claudia Selene Mora Trujillo⁴⁰, Manuel Ugarte-Gil⁴¹, Ernesto Zavala Flores⁴², Ricardo Robaina⁴³, Gonzalo Silveira⁴⁴, Federico Zazzetti⁴⁵, Ashley Orillion⁴⁶, Guillermo Pons-Estel⁴⁷, Bernardo Pons-Estel² and Urbano Sbarigia⁴⁸, ¹Grupo Oroño - Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Santa Fe, Argentina, ²Grupo Oroño - Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina, ³Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, ⁴Hospital Italiano de Córdoba, Cordoba, Argentina, ⁵Hospital Córdoba, Córdoba, Argentina, ⁶Sanatorio Británico, Paraná, Argentina, ⁷Hospital Padilla, San Miguel de Tucumán, Argentina, ⁸Instituto Lanari, Buenos Aires, Argentina, ⁹Hospital das Clinicas, Univerisad Federal de Goias, Goiania, Brazil, ¹⁰Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil, ¹¹Universidade Federal de Pernambuco, Recife, Brazil, ¹²Universidad Federal São Paulo, São Paulo, Brazil, ¹³Universidad San Sebastián, Santiago, Chile, ¹⁴Clínica de la Costa Ltda., Barranquilla, Colombia, ¹⁵Reumavance Group, Rheumatology section, Department of Internal Medicine, Fundación Santa Fe de Bogotá University Hospital. Bogota, Colombia; Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia. Bogota, Colombia; Department of Internal Medicine. School of Medicine, Universidad de Los Andes, Bogotá, Colombia, ¹⁶Hospital Luis Vernaza, Guayaquil, Ecuador, ¹⁷IMSS, Ciudad de México, Mexico, ¹⁸Centro Médico Nacional Siglo XXI, Ciudad de México, Mexico, ¹⁹Instituto Nacional de Cardiología, Ciudad de México, Mexico, ²⁰CEIBAC, SC, Guadalajara, Mexico, ²¹Hospital Central and Faculty of Medicine, UASLP, San Luis Potosí, Mexico, ²²Hospital Universitario “Dr. José Eleuterio Gonzalez", Monterrey, Mexico, ²³Hospital de Clínicas Paraguay, Asunción, Paraguay, ²⁴Hospital Docente Padre Billini, Santo Domingo, Dominican Republic, ²⁵MSP, Salta, Argentina, ²⁶Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil, ²⁷Hospital Italiano de Buenos Aires, Olivos, Argentina, ²⁸The University of Alabama at Birmingham, Oakland, ²⁹Rheumatology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain, ³⁰Instituto de Investigaciones Teóricas y Aplicadas. Facultad de Ciencias Económicas y Estadistica. Universidad Nacional de Rosario, Santa Fe, Argentina, ³¹Hospital Privado Universitario de Córdoba, Cordoba, Argentina, ³²Hospital HIGA San Martín, Buenos Aires, Argentina, ³³Hospital General de Agudos J.M. Ramos Mejía, Buenos Aires, Argentina, ³⁴CEMIC- Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina, ³⁵Hospital Universitario Pedro Ernesto, UERJ, Rio de Janiero, Brazil, ³⁶Hospital del Salvador, Santiago, Chile, ³⁷Fundación Valle del Lili, Calí, Colombia, ³⁸Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico, ³⁹Hospital de Clínicas I, Montevideo, Uruguay, ⁴⁰Hospital Nacional Edgardo Rebagliatti Martins, Lima, Peru, ⁴¹Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru, ⁴²Hospital Cayetano Heredia, San Martín de Porres Distric, Peru, ⁴³Clínica Médica C, Hospital de Clínicas, UDELAR, Montevideo, Uruguay, ⁴⁴Grupo de Investigacion de EAIS y Reumatológicas, A Coruña, Spain, ⁴⁵Janssen Medical Affairs Global Services, LLC, Buenos Aires, Argentina, ⁴⁶Janssen, Horsham, PA, ⁴⁷CREAR, Rosario, Argentina, ⁴⁸Johnson & Johnson, Beerse, Belgium

Background/Purpose: Systemic lupus erythematosus (SLE) is a complex and heterogeneous autoimmune disease. The identification of patient subgroups or clusters may be useful for the management of the disease. The aim of this study is to describe different SLE clusters according to sociodemographic variables and cumulative clinical and serological variables.  

Methods: GLADEL 2.0 (GLADEL, Grupo Latino Americano De Estudio del Lupus) is an ongoing observational prevalent and incident cohort initiated in 2019. Patients in this cohort were categorized according to renal involvement: Group I (Lupus Nephritis (LN) never); Group II (inactive LN; prevalent renal involvement in the past and currently inactive); Group III (active LN; prevalent renal involvement and currently active) and Group IV (active LN; incident renal involvement). The variables chosen at cohort entry to stratify patients with similar profiles and construct the clusters were selected from the sociodemographic and cumulative clinical and serological variables. Hierarchical cluster analyses were performed by the Ward method on a distance matrix using the Gower’s method. A p-value < 0.05 was considered significant.

Results: A total of 560 SLE patients were included in this analysis. Three clusters were identified. Cluster 1 (n=269) was characterized by more cutaneous, articular, renal and serosal involvement; the most important serological manifestation was positive anti-dsDNA. Cluster 2 (n=194) was represented by patients who rarely had renal involvement and the most frequent clinical manifestations were cutaneous and hematological; the most frequent serological manifestations were the presence of antiphospholipid antibodies (aPLs). Cluster 3 (n=97) was characterized by a lower frequency of clinical and serological involvements, with the exception of neurological domain. Clusters 1 and 2 share hematologic manifestations and hypocomplementemia. No major differences according of ethinicity were found among clusters (Table 1).

Conclusion: In this Latin-American cohort, three patient clusters were identified. Cluster 1 patients were characterized by renal, articular, cutaneous and serositis involvement and anti-dsDNA antibodies and hypocomplementemia, Cluster 2 patients were characterized by hematologic and cutaneous involvement and antiphospholipid antibodies and hypocomplementemia. On the contrary, Cluster 3 patients presented fewer serological findings but a higher frequency of neurological involvement. Follow up of patients in this cohort will allow for elucidation of the relationship of these clusters with SLE outcomes. Autoantibodies assessed in a central laboratory may further help in the identification of these clusters.
Table 1. Clustering of GLADEL 2.0 SLE patients into three clusters by cluster analysis based on sociodemographic, serological and clinical variables
Disclosures: R. Quintana, None; R. Nieto, None; M. Scolnik, AbbVie/Abbott, Amgen, Bristol-Myers Squibb(BMS), Eli Lilly, Janssen, Pfizer, GlaxoSmithKlein(GSK), Roche; N. Meras, None; C. Otaduy, None; M. Sattler, None; L. González Lucero, None; N. Perez, None; A. Silva, None; O. Monticielo, GSK, AstraZeneca; A. Duarte, None; E. Reis Neto, None; M. Mimica, None; G. Aroca Martinez, None; G. Quintana-Lopez, None; M. Moreno Alvarez, None; M. Saavedra Salinas, GlaxoSmithKlein(GSK), AbbVie/Abbott; M. Portela, None; L. Silveira, None; I. García Valladares, None; C. Abud-Mendoza, None; J. Esquivel-Valerio, None; M. Duarte, None; R. Muñoz Louis, None; V. Juárez, None; E. Ferreira Borba Neto, None; L. Catoggio, None; G. Alarcón, None; J. Puerta, AstraZeneca, Eli Lilly, Bristol-Myers Squibb(BMS), GlaxoSmithKlein(GSK), Pfizer, Merck/MSD; G. Harvey, None; E. Novati, None; V. Arturi, None; W. Grageda, None; C. Pisoni, AbbVie/Abbott, Pfizer, Elea Phoenix, International League of Associations of Rheumatology; F. Machado Riobeiro, None; E. Figueiredo Neves Yuki, None; I. Guerra Herrera, None; G. Tobón, None; A. Cadena Bonfanti, None; H. Fragoso-Loyo, None; M. de Martinez, None; C. Mora Trujillo, None; M. Ugarte-Gil, Janssen, Pfizer; E. Zavala Flores, None; R. Robaina, None; G. Silveira, None; F. Zazzetti, Janssen Medical Affairs Global Services, LLC; A. Orillion, Janssen; G. Pons-Estel, Janssen, GSK, Pfizer, Werfen/Inova, Novartis; B. Pons-Estel, None; U. Sbarigia, Janssen.