TY - JOUR
T1 - Association of mycophenolate and azathioprine use with cognitive function in systemic lupus
AU - Dobrowolski, Chrisanna
AU - McGinley, John
AU - Fazzari, Melissa
AU - Su, Jiandong
AU - Bingham, Kathleen S.
AU - Anderson, Nicole
AU - Ruttan, Lesley
AU - Beaton, Dorcas E.
AU - Wither, Joan E.
AU - Tartaglia, Maria Carmela
AU - Kakvan, Mahta
AU - Bonilla, Dennisse
AU - Choi, May Y.
AU - Fritzler, Marvin J.
AU - Diaz Martinez, Juan Pablo
AU - Katz, Patricia
AU - Green, Robin
AU - Putterman, Chaim
AU - Touma, Zahi
N1 - Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - Objectives: Cognitive dysfunction (CD) is a common manifestation of SLE that can have detrimental consequences for those affected. To date, no treatments have been approved for SLE-CD. This study aims to assess the association of azathioprine (AZA) and mycophenolate (MMF) use with SLE-CD, given that these medications have demonstrated neuroprotective qualities in prior studies. Methods: Consecutive adult SLE patients presenting to a single healthcare center were considered for participation. The ACR neuropsychological battery for SLE was administered to consenting patients at 0, 6 and 12 months. Scores were compared with age-And sex-matched controls. Primary outcome was CD, defined as a z-score ≤-1.5 in two or more cognitive domains. Mixed-effects logistic regression models were constructed to estimate the odds of CD with respect to AZA and MMF use. Results: A total of 300 participants representing 676 patient visits completed the study; 114 (38%) met criteria for CD at baseline. The cumulative AZA dose (g/kg) was associated with reduced odds of CD [odds ratio (OR) 0.76 (95% CI 0.58, 0.98), P = 0.04]. Years of AZA treatment was also associated with reduced odds of CD [OR 0.72 (95% CI 0.54, 0.97), P = 0.03]. MMF use was not associated with CD. Conclusion: AZA use was associated with significantly lower odds of SLE-CD, while MMF use was not. Additional studies are warranted to further investigate the relationship of AZA and SLE-CD.
AB - Objectives: Cognitive dysfunction (CD) is a common manifestation of SLE that can have detrimental consequences for those affected. To date, no treatments have been approved for SLE-CD. This study aims to assess the association of azathioprine (AZA) and mycophenolate (MMF) use with SLE-CD, given that these medications have demonstrated neuroprotective qualities in prior studies. Methods: Consecutive adult SLE patients presenting to a single healthcare center were considered for participation. The ACR neuropsychological battery for SLE was administered to consenting patients at 0, 6 and 12 months. Scores were compared with age-And sex-matched controls. Primary outcome was CD, defined as a z-score ≤-1.5 in two or more cognitive domains. Mixed-effects logistic regression models were constructed to estimate the odds of CD with respect to AZA and MMF use. Results: A total of 300 participants representing 676 patient visits completed the study; 114 (38%) met criteria for CD at baseline. The cumulative AZA dose (g/kg) was associated with reduced odds of CD [odds ratio (OR) 0.76 (95% CI 0.58, 0.98), P = 0.04]. Years of AZA treatment was also associated with reduced odds of CD [OR 0.72 (95% CI 0.54, 0.97), P = 0.03]. MMF use was not associated with CD. Conclusion: AZA use was associated with significantly lower odds of SLE-CD, while MMF use was not. Additional studies are warranted to further investigate the relationship of AZA and SLE-CD.
KW - AZA
KW - SLE
KW - cognition
KW - mycophenolate
KW - neuropsychiatric SLE
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U2 - 10.1093/rheumatology/keac540
DO - 10.1093/rheumatology/keac540
M3 - Article
C2 - 36135792
AN - SCOPUS:85159257333
SN - 1462-0324
VL - 62
SP - 1860
EP - 1869
JO - Rheumatology (United Kingdom)
JF - Rheumatology (United Kingdom)
IS - 5
ER -