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Independent associations of lymphopenia and neutropenia in patients with systemic lupus erythematosus: a longitudinal, multinational study

Kandane-Rathnayake R 1 , Louthrenoo W 2 , Golder V 1 , Luo SF 3 , Wu YJ 3 , Lateef A 4 Show all authors , Cho J 4 , Li Z 5 , An Y 5 , Hamijoyo L 6 , Navarra S 7 , Zamora L 7 , Katsumata Y 8 , Harigai M 8 , Sockalingam S 9 , Chan M 10 , Chen YH 11 , O'Neill S 12 , Goldblatt F 13 , Hao Y 14 , Zhang Z 14 , Kikuchi J 15 , Takeuchi T 15 , Lau CS 16 , Nikpour M 17 , Morand E 1 , Hoi A 1 , Asia Pacific Lupus Collaboration

Affiliations 

  • 1 Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
  • 2 Department of Internal Medicine, Faculty of Medicine, Chiang Mai University Hospital, Thailand
  • 3 Chang Gung Memorial Hospital, Rheumatology, Allergy and Immunology, Taipei and Keelung, Taiwan
  • 4 National University Hospital, University Medicine Cluster, Singapore, Singapore
  • 5 Department of Rheumatology and Immunology, People's Hospital, Peking University Health Science Center, Beijing, China
  • 6 Division of Rheumatology, Padjadjaran University/Hasan Sadikin General Hospital, Bandung, Indonesia
  • 7 Section of Rheumatology, University of Santo Tomas Hospital, Manila, Philippines
  • 8 Department of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
  • 9 Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 10 Rheumatology, Allergy & Immunology, Tan Tock Seng Hospital, Singapore, Singapore
  • 11 Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
  • 12 Liverpool Hospital and the Ingham Institute for Applied Medical Research, Rheumatology, Liverpool, NSW
  • 13 Department of Rheumatology, Royal Adelaide Hospital
  • 14 Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
  • 15 Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan
  • 16 The University of Hong Kong, Medicine, Hong Kong, Hong Kong
  • 17 The University of Melbourne at St. Vincent's Hospital, Medicine and Rheumatology, Melbourne, Victoria, Australia
Rheumatology (Oxford), 2021 Nov 03;60(11):5185-5193.
PMID: 33693676 DOI: 10.1093/rheumatology/keab217

Abstract

OBJECTIVE: The prevalence and associations of leucopenia in SLE remain incompletely understood. We evaluated associations of disease activity and medication use with leucopenia (lymphopenia and neutropenia) in a multinational, prospectively followed SLE cohort.

METHODS: Data from the Asia Pacific Lupus Collaboration cohort, in which disease activity and medications were prospectively captured from 2013 to 2018, were used. Predictors of lymphopenia (lymphocyte count <0.8 × 109/l) and neutropenia (neutrophil count <1.5 × 109/l) were examined using multiple failure, time-dependent survival analyses.

RESULTS: Data from 2330 patients and 18 287 visits were analysed. One thousand and eighteen patients (43.7%) had at least one episode of leucopenia; 867 patients (37.2%) had lymphopenia, observed in 3065 (16.8%) visits, and 292 (12.5%) patients had neutropenia, in 622 (3.4%) visits. After multivariable analyses, lymphopenia was associated with overall disease activity, ESR, serology, prednisolone, AZA, MTX, tacrolimus, CYC and rituximab use. MTX and ciclosporin were negatively associated with neutropenia. Lupus low disease activity state was negatively associated with both lymphopenia and neutropenia.

CONCLUSION: Both lymphopenia and neutropenia were common in SLE patients but were differentially associated with disease and treatment variables. Lymphopenia and neutropenia should be considered independently in studies in SLE.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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