Factors and outcomes related to clinical inertia in systemic lupus erythematosus: a multicentre LUNA cohort study.

Abstract

OBJECTIVES This study aimed to identify predictors of clinical inertia in systemic lupus erythematosus (SLE) management and to evaluate its impact on clinical outcomes. METHODS A historical cohort study was conducted using data from the multicentre LUNA cohort in Japan. The 365 patients with active disease 1 year before baseline (SLE Disease Activity Index score >4 or active gastrointestinal lesions or haemolytic anaemia) were classified by baseline disease activity and treatment intensification status over 1 year into non-intensification (n = 247) vs intensification (n = 118) groups. Furthermore, the clinical inertia group (n = 116), defined as sustained active disease without intensification, was compared with the non-clinical inertia group (n = 249), which comprised all other patients. Regression analyses assessed predictors and outcomes, including damage accrual, disease activity, quality of life (QoL), and patient satisfaction. RESULTS Non-intensification was associated with larger increases in glucocorticoid-related damage, while clinical inertia was linked to greater increases in overall and glucocorticoid-related damage. Non-intensification and clinical inertia correlated with a tendency towards reduced QoL across several domains. Hydroxychloroquine use and fewer concomitant immunosuppressants predicted non-intensification of treatment, whereas female sex and greater damage accrual predicted clinical inertia; older age showed similar but non-significant trends for both outcomes. CONCLUSION Because clinical inertia can drive damage accrual and QoL deterioration, avoiding clinical inertia is a therapeutic priority. Regular reassessment of treatment strategy is essential for older patients, women, and those with greater damage. Proactive tailoring of treatment to individual risk profiles can arrest clinical inertia and improve long-term outcomes.