{
  "abstract": "Objectives Evidence regarding therapeutic strategies and long-term treatment outcomes for autoimmune hemolytic anemia(AIHA) in lupus patients remains limited, and data defining the optimal timing for steroid-sparing immunosuppressive(IS) therapy are scarce.This study aimed to evaluate treatment outcomes and identify predictors of response in patients with lupus-associated severe AIHA.Methods In this retrospective multicenter study, patients who fulfilled the 2019 SLE classification criteria and were diagnosed with AIHA were included, with a minimum follow-up of six months. Treatment responses and relapse histories were assessed.Results The study included 90 patients (female/male:82/8) with SLE-associated AIHA, who were followed for a median 53.1 months (IQR 22.6-94.2). The mean age was 39.8±15.3 years, and the median baseline hemoglobin level was 7.0 g/dL (IQR 5.87–7.8). Initial treatment for AIHA consisted of corticosteroids(CS) alone in 88.9% of patients (48 high-dose/pulse,31 moderate,1 low),CS combined with IVIg in 10%, and IVIg alone in 1.1%. An early (first-month) response to initial therapy was observed in 92.2% of patients, including 48 complete and 35 partial responses. Since AIHA diagnosis, 77 patients (85.5%) received early steroid-sparing IS agent or underwent splenectomy, whereas 13 patients were treated with CS alone. Patients who did not receive early IS therapy had significantly higher rates of late treatment failure or relapse compared to those who received early IS therapy (53.8%vs.16.9%, p=0.006) ( table 1,figure1) Early IS therapy was the only independent predictor of positive treatment response (p=0.006;OR=5.7,95%CI:1.6-19.9). The presence of less severe anemia at baseline was not significantly associated with treatment outcomes (hemoglobin 8–10g/dL[n=19] vs.<8 g/dL[n=71], p=NS). Second-line therapy was required in 20 patients, achieving an overall response rate of 80%. At the end of follow-up, 2 patients (2.2%) were refractory and 7(7.7%) had died,with no deaths attributable to AIHA.Abstract PO:10:272 Table 1Long-term treatments and response rates in AIHAAbstract PO:10:272 Figure 1Response rates to first-line therapy in patients with AIHAConclusions In the treatment of SLE-associated AIHA, early response to CS therapy was favorable, and the early use of steroid-sparing IS agents was identified as an independent factor associated with lower rates of treatment failure.Additionally, patients with less severe anemia appeared to have a comparable prognosis. These findings underscore the importance of early initiation of IS therapy and highlight the need for further research to refine the hemoglobin threshold for treatment initiation.",
  "authors": [
    {
      "affiliations": [
        "Independent Researcher, Istanbul, Turkey"
      ],
      "name": "Cansu Akleylek"
    },
    {
      "affiliations": [
        "Gülhane Training and Research Hospital, Department of Rheumatology, Ankara, Turkey"
      ],
      "name": "Gül Sandal Uzun"
    },
    {
      "affiliations": [
        "Marmara University, Faculty of Medicine, Department of Rheumatology, Istanbul, Turkey"
      ],
      "name": "Aida Shikhaliyeva"
    },
    {
      "affiliations": [
        "Basaksehir Cam and Sakura City Hospital, Department of Rheumatology, Istanbul, Turkey"
      ],
      "name": "Aysenur Yilmaz"
    },
    {
      "affiliations": [
        "Basaksehir Cam and Sakura City Hospital, Department of Rheumatology, Istanbul, Turkey"
      ],
      "name": "Fatima Gül Gülbahce Incesu"
    },
    {
      "affiliations": [
        "Ankara Bilkent City Hospital, Department of Rheumatology, Ankara, Turkey"
      ],
      "name": "Elif Akyazı Sener"
    },
    {
      "affiliations": [
        "Eskisehir Osmangazi University, Faculty of Medicine, Department of Rheumatology, Eskisehir, Turkey"
      ],
      "name": "Nazife Sule Yasar Bilge"
    },
    {
      "affiliations": [
        "Kocaeli University, Faculty of Medicine, Department of Rheumatology, Kocaeli, Turkey"
      ],
      "name": "Andac Komac"
    },
    {
      "affiliations": [
        "Bursa Uludag University, Faculty of Medicine, Department of Rheumatology, Bursa, Turkey"
      ],
      "name": "Burcu Yagiz"
    },
    {
      "affiliations": [
        "Gülhane Training and Research Hospital, Department of Rheumatology, Ankara, Turkey"
      ],
      "name": "Berkay Soysal"
    },
    {
      "affiliations": [
        "Ege University, Faculty of Medicine, Department of Rheumatology, Izmir, Turkey"
      ],
      "name": "Rabia Özmen"
    },
    {
      "affiliations": [
        "Hacettepe University, Faculty of Medicine, Department of Rheumatology, Ankara, Turkey"
      ],
      "name": "Deniz Dönmez"
    },
    {
      "affiliations": [
        "Gazi University, Faculty of Medicine, Department of Rheumatology, Ankara, Turkey"
      ],
      "name": "Rahime Duran"
    },
    {
      "affiliations": [
        "Izmir Katip Celebi University, Faculty of Medicine, Department of Rheumatology, Izmir, Turkey,"
      ],
      "name": "Özge Yogurtcu"
    },
    {
      "affiliations": [
        "Dokuz Eylul University, Faculty of Medicine, Department of Rheumatology, Izmir, Turkey"
      ],
      "name": "Hasan Yardimci"
    },
    {
      "affiliations": [
        "Kartal Dr. Lütfi Kirdar City Hospital, Department of Rheumatology, Istanbul, Turkey"
      ],
      "name": "Zeynep Fural"
    },
    {
      "affiliations": [
        "Mugla Sitki Kocman University, Faculty of Medicine, Department of Rheumatology, Mugla, Turkey"
      ],
      "name": "Melike Ersoy"
    },
    {
      "affiliations": [
        "Tekirdag City Hospital, Department of Rheumatology, Tekirdag, Turkey"
      ],
      "name": "Berna Yurttas"
    },
    {
      "affiliations": [
        "Izmir City Hospital, Department of Rheumatology, Izmir, Turkey"
      ],
      "name": "Tuba Demirci Yildirim"
    },
    {
      "affiliations": [
        "Dokuz Eylul University, Faculty of Medicine, Department of Rheumatology, Izmir, Turkey"
      ],
      "name": "Handan Yarkan Tugsal"
    },
    {
      "affiliations": [
        "Gülhane Training and Research Hospital, Department of Rheumatology, Ankara, Turkey"
      ],
      "name": "Sedat Yilmaz"
    },
    {
      "affiliations": [
        "Marmara University, Faculty of Medicine, Department of Rheumatology, Istanbul, Turkey"
      ],
      "name": "Fatma Alibaz Öner"
    },
    {
      "affiliations": [
        "Basaksehir Cam and Sakura City Hospital, Department of Rheumatology, Istanbul, Turkey"
      ],
      "name": "Cemal Bes"
    },
    {
      "affiliations": [
        "Ankara Bilkent City Hospital, Department of Rheumatology, Ankara, Turkey"
      ],
      "name": "Hakan Babaoglu"
    },
    {
      "affiliations": [
        "Eskisehir Osmangazi University, Faculty of Medicine, Department of Rheumatology, Eskisehir, Turkey"
      ],
      "name": "Timucin Kasifoglu"
    },
    {
      "affiliations": [
        "Kocaeli University, Faculty of Medicine, Department of Rheumatology, Kocaeli, Turkey"
      ],
      "name": "Ayten Yazici"
    },
    {
      "affiliations": [
        "Kocaeli University, Faculty of Medicine, Department of Rheumatology, Kocaeli, Turkey"
      ],
      "name": "Ayse Cefle"
    },
    {
      "affiliations": [
        "Bursa Uludag University, Faculty of Medicine, Department of Rheumatology, Bursa, Turkey"
      ],
      "name": "Yavuz Pehlivan"
    },
    {
      "affiliations": [
        "Ege University, Faculty of Medicine, Department of Rheumatology, Izmir, Turkey"
      ],
      "name": "Figen Yargucu Zihni"
    },
    {
      "affiliations": [
        "Ege University, Faculty of Medicine, Department of Rheumatology, Izmir, Turkey"
      ],
      "name": "Gonca Karabulut"
    },
    {
      "affiliations": [
        "Hacettepe University, Faculty of Medicine, Department of Hematology, Ankara, Turkey"
      ],
      "name": "Elifcan Aladag Karakulak"
    },
    {
      "affiliations": [
        "Hacettepe University, Faculty of Medicine, Department of Rheumatology, Ankara, Turkey"
      ],
      "name": "Ömer Karadag"
    },
    {
      "affiliations": [
        "Gazi University, Faculty of Medicine, Department of Rheumatology, Ankara, Turkey"
      ],
      "name": "Abdulsamet Erden"
    },
    {
      "affiliations": [
        "Izmir Katip Celebi University, Faculty of Medicine, Department of Rheumatology, Izmir, Turkey,"
      ],
      "name": "Servet Akar"
    },
    {
      "affiliations": [
        "Dokuz Eylul University, Faculty of Medicine, Department of Rheumatology, Izmir, Turkey"
      ],
      "name": "Ismail Sari"
    },
    {
      "affiliations": [
        "Kartal Dr. Lütfi Kirdar City Hospital, Department of Rheumatology, Istanbul, Turkey"
      ],
      "name": "Sibel Yilmaz Öner"
    },
    {
      "affiliations": [
        "Kartal Dr. Lütfi Kirdar City Hospital, Department of Rheumatology, Istanbul, Turkey"
      ],
      "name": "Mehmet Engin Tezcan"
    },
    {
      "affiliations": [
        "Mugla Sitki Kocman University, Faculty of Medicine, Department of Rheumatology, Mugla, Turkey"
      ],
      "name": "Emine Figen Tarhan"
    },
    {
      "affiliations": [
        "Ege University, Faculty of Medicine, Department of Rheumatology, Izmir, Turkey"
      ],
      "name": "Gökhan Keser"
    },
    {
      "affiliations": [
        "Marmara University, Faculty of Medicine, Department of Rheumatology, Istanbul, Turkey"
      ],
      "name": "Haner Direskeneli"
    },
    {
      "affiliations": [
        "Medipol University, Faculty of Medicine, Department of Rheumatology, Istanbul, Turkey"
      ],
      "name": "Neslihan Yilmaz"
    }
  ],
  "title": "PO:10:272 Long-term outcomes and predictors of treatment response in lupus patients with severe autoimmune hemolytic anemia: results from the Turkish lupus study group",
  "uid": "c38cb7fe-e233-5ba7-8257-362216072006"
}