Equitable Access to Lupus Treatment Essential for Improving Minority Patient Outcomes: Margrit Wiesendanger, MD, PhD

Margrit Wiesendanger, MD, PhD, of Icahn School of Medicine at Mount Sinai, continues her conversation with The American Journal of Managed Care^®, highlighting how findings from the LUMINA study and the National Lupus Patient Registry underscore the critical role of social determinants of health and equitable treatment access in improving lupus outcomes, particularly among Hispanic and African American patients.

Watch parts 1 and 2 to learn more about the clinical presentation of lupus and the evolving treatment landscape.

This transcript was lightly edited; captions were auto-generated.

Transcript

The LUMINA study found that Hispanic patients with lupus are more likely to experience organ system involvement, more active disease, and lower levels of social support than White patients with lupus. Can you expand on these findings by discussing how social determinants of health impact lupus care and outcomes?

The LUMINA study was a groundbreaking study. It is based on a multiethnic cohort of patients with systemic lupus. It was led by Graciela Alarcon, MD, to better understand the features that impact the course of the disease and its prognosis.

Her group importantly found that the seriousness of lupus among Hispanics, in many ways, mirrors the disease observed in African Americans. There is a similar frequency of renal disease, about 60%, in contrast with what we observe among White patients, where it is closer to 25%. There is also more rapid and greater damage accrual, greater disease activity, and reduced survival.

Dr Alarcon also noted that when socioeconomic variables were taken into consideration, that accounted for some of the differences observed between the groups. Specifically, poverty has a greater impact than ethnicity when it comes to survival in patients with lupus.

Hydroxychloroquine has a protective effect in terms of survival and damage accrual, independent of ethnicity; that was another key finding. Hydroxychloroquine, because it's a relatively low-potency medicine, had mainly been prescribed to patients who had controlled lupus and no current organ activity.

But what Dr Alarcon discovered is that hydroxychloroquine should be given to every patient with lupus, even those who are suffering a great disease burden, because it protects them, regardless of their ethnic background. Now, we do that. It's considered an anchor medicine for lupus, we have to use it.

Can you explain what the National Lupus Patient Registry is and how it helps improve our understanding of lupus and its impact on the US population?

The National Lupus Patient Registry was established in 2003 by an act of Congress and is housed at the CDC. Data from this registry has informed our understanding of the prevalence of lupus, how the condition affects patients, and studies currently funded by the registry are pursuing several important goals.

One is that we are cataloging the treatment history, access to health care, and the natural history of the disease in participants with lupus. We're collecting patient-reported outcomes, such as level of fatigue and severity of joint pain, and also collecting samples of blood, urine, and tissue to perform mechanistic studies so we can get a better understanding of the biology of the condition.

We want to understand the disproportionate impact of lupus on certain populations, and we want to support the collaborative use of data for researchers across the US.