Session Information
Date: Tuesday, November 10, 2015
Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment Poster Session III
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Treating to a
target of remission or low disease activity state (LDAS) is an attractive
potential therapeutic approach in SLE. Recently, LDAS and remission in SLE have
been proposed by the Asia-Pacific Lupus Collaboration (APLC) and the
Definitions of Remission in SLE (DORIS) consensus panel, respectively. We
identified 1228 of the 1506 patients who completed enrollment in a real-world
SLE registry composed of 17 centers in the United States and Canada who had at
least ≥ 1 follow-up visit through one year following enrollment, and
we evaluated the incidence and predictors of achieving these outcomes.
Methods: Using
definitions created by the APLC and DORIS, subjects were classified into 4 mutually
exclusive groups based on the lowest remission or LDAS category they reached
and maintained for ≥ 1 year: 1) Not optimally controlled:
SLEDAI > 4, prednisone > 7.5 mg/d OR physician global assessment (PGA)
> 1.0; 2) LDAS: SLEDAI ≤ 4, prednisone ≤ 7.5
mg/d AND PGA ≤ 1.0 with immunosuppressive drugs being allowed; 3) Remission
On Therapy: Prednisone ≤ 5mg and/or maintenance
immunosuppressive agents allowed, SLEDAI = 0 AND PGA ≤ 0.5; 4) Remission
Off Therapy: No steroids or immunosuppressive agents, SLEDAI = 0 AND PGA ≤
0.5. Characteristics of subjects at baseline were compared using chi-square and
analysis of variance tests (Table 1). A multinomial logistic regression
(ordered logit) ranking outcomes from remission off therapy (lowest) to not
optimally controlled disease (highest) was used to examine the multivariable
association between baseline predictors and ordered outcome.
Results: Among 1228
patients, 91.6 % were female, mean age was 41.1 years (±13.3 y) and median
duration of disease was 9.8 years (interquartile range [IQR] 4.96 – 16.34 y).
At follow-up (median duration of 2.05 years [IQR 1.54 – 2.44 y]); 930
(75.7%) patients were classified as not optimally controlled; 139 (14.9%)
achieved LDAS; and 93 (7.57%) and 66 (5.37%) achieved remission on or off
therapy, respectively, for ≥ 1 year. Among the groups, statistically
significant differences were observed for age at diagnosis, steroid and
immunosuppressive usage, PGA, patient global assessment of disease,
SELENA-SLEDAI scores and ACR criteria count (Table 1). In multivariable analysis,
decreased odds of a more desirable ordered outcome category were observed for
increasing SELENA-SLEDAI scores (odds ratio [OR] 0.89, 95% CI 0.84-0.94),
steroid usage (OR 0.74, 95% CI 0.84-0.94) and increasing patient global
assessment (OR 0.993, 95% CI 0.987-0.999).
Conclusion: Optimal control
of SLE disease activity through one year, defined as LDAS or remission on/off
therapy, was achieved in 24.3 % of patients in the LCTC cohort. Baseline
predictors of better control of SLE at follow-up included lower SELENA-SLEDAI
scores, no steroids and lower patient global assessment of disease.
|
Table 1. Comparison of enrollment demographic, medication, and clinical characteristics by disease activity group |
|||||
|
|
Not optimally controlled |
Low disease activity |
Remission on meds |
Remission off meds |
p-value* |
|
N |
930 |
139 |
93 |
66 |
|
|
DEMOGRAPHICS |
|
|
|
|
|
|
Age at diagnosis |
|
|
|
|
|
|
Mean |
28.9±12.1 |
30.3±13.8 |
29.7±12.4 |
34.6±12.5 |
0.0046 |
|
Category (%) |
|
|
|
|
|
|
0-20 years |
29.1 |
27.5 |
26.4 |
16.1 |
0.0273 |
|
21-35 years |
44.2 |
41.3 |
45.1 |
35.5 |
|
|
36-50 years |
21.1 |
21.0 |
22.0 |
40.3 |
|
|
≥51 years |
5.6 |
10.1 |
6.6 |
8.1 |
|
|
Sex (%) |
|
|
|
|
|
|
Male |
8.3 |
7.3 |
7.7 |
12.9 |
0.5836 |
|
Female |
91.7 |
92.7 |
92.3 |
87.12 |
|
|
Race |
|
|
|
|
|
|
White Non-Hispanic |
39.2 |
29.7 |
36.3 |
45.2 |
0.4454 |
|
White Hispanic |
7.7 |
6.5 |
11.0 |
4.8 |
|
|
Black Hispanic |
1.1 |
2.2 |
0.0 |
1.6 |
|
|
Black Non-Hispanic |
35.2 |
41.3 |
31.9 |
27.4 |
|
|
Asian |
9.3 |
8.7 |
11.0 |
12.9 |
|
|
Other |
7.4 |
11.6 |
9.9 |
8.1 |
|
|
Smoking status (%) |
|
|
|
|
|
|
Current |
8.8 |
6.5 |
5.5 |
3.2 |
0.4266 |
|
Former |
19.0 |
23.9 |
19.8 |
24.2 |
|
|
Never |
72.2 |
69.6 |
74.7 |
72.6 |
|
|
Insurance (%) |
|
|
|
|
|
|
None |
4.3 |
4.6 |
1.1 |
0.0 |
0.1204 |
|
Medicaid |
11.8 |
19.2 |
10.1 |
13.8 |
|
|
Medicare |
9.2 |
10.0 |
7.9 |
3.5 |
|
|
Commercial/HMO |
59.7 |
55.4 |
60.7 |
60.3 |
|
|
Multiple |
15.0 |
10.8 |
20.2 |
22.4 |
|
|
MEDICATIONS |
|
|
|
|
|
|
Plaquenil (%) |
69.9 |
69.8 |
78.5 |
72.7 |
0.3609 |
|
Steroids (%) |
58.9 |
66.2 |
53.8 |
13.6 |
<0.0001 |
|
Immunosuppresants (%) |
54.78 |
62.6 |
66.7 |
6.1 |
<0.0001 |
|
CLINICAL |
|
|
|
|
|
|
Mean physician global assessment |
0.71±0.70 |
0.81±0.61 |
0.35±0.51 |
0.22±0.47 |
<0.0001 |
|
Mean patient global assessment |
30.87±26.58 |
30.81±25.41 |
22.62±21.24 |
13.86±18.46 |
<0.0001 |
|
Mean SLEDAI |
3.24±3.52 |
3.67±3.18 |
1.13±1.66 |
0.65±1.39 |
<0.0001 |
|
Mean SLICC |
1.26±1.75 |
1.30±1.64 |
1.63±2.50 |
1.29±2.11 |
0.3493 |
|
Mean disease duration |
11.51±8.87 |
11.03±9.57 |
13.06±9.99 |
12.45±10.64 |
0.3219 |
|
Mean ACR criteria count |
5.58±1.53 |
5.73±1.62 |
5.51±1.64 |
5.08±1.41 |
0.0464 |
|
Malar rash (%) |
50.7 |
52.5 |
52.7 |
43.9 |
0.6736 |
|
Renal disorder (%) |
41.2 |
48.9 |
47.3 |
21.2 |
0.0013 |
|
Oral ulcers (%) |
38.0 |
39.6 |
37.6 |
19.7 |
0.0264 |
|
Antinuclear antibody (%) |
91.2 |
94.2 |
93.6 |
92.4 |
0.5767 |
|
Serositis (%) |
32.3 |
35.3 |
26.9 |
25.8 |
0.3918 |
|
Photosensitivity (%) |
41.9 |
38.1 |
45.2 |
43.9 |
0.7218 |
|
Hematologic disorder (%) |
57.0 |
59.7 |
51.6 |
62.1 |
0.5294 |
|
Immunologic disorder (%) |
75.3 |
87.8 |
77.4 |
72.7 |
0.0106 |
|
Discoid rash (%) |
15.1 |
17.3 |
12.9 |
13.6 |
0.8082 |
|
Neurologic disorder (%) |
11.3 |
13.0 |
18.3 |
13.6 |
0.2465 |
|
Arthritis (%) |
81.3 |
82.7 |
75.3 |
68.2 |
0.0334 |
|
*Estimated from chi-square and analysis of variance for categorical and continuous variables, respectively |
|||||
To cite this abstract in AMA style:
Ko K, Levine AB, Griffin R, Dvorkina O, Sheikh S, Yazdany J, Furie R, Aranow C. Baseline Predictors of Remission and Low Disease Activity Using Recently Defined International Criteria in a Multi-Center Lupus Registry Cohort [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/baseline-predictors-of-remission-and-low-disease-activity-using-recently-defined-international-criteria-in-a-multi-center-lupus-registry-cohort/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/baseline-predictors-of-remission-and-low-disease-activity-using-recently-defined-international-criteria-in-a-multi-center-lupus-registry-cohort/