Session Information
Date: Sunday, November 5, 2017
Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment Poster I: Biomarkers and Outcomes
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Prolonged clinical remission is a desirable, though rare outcome in systemic lupus erythematosus (SLE). We recently showed that low disease activity (LDA) state confers the same risk as complete remission with regard to damage accumulation and flare rate at two years. The aim of the present study was to assess the impact of prolonged LDA (for 10 years) on such outcomes as compared to patients who achieved complete remission.
Methods: The inception cohort of a large lupus clinic (patients enrolled within 18 months of diagnosis) was investigated. Patients selected had a minimum follow-up of 10 years and no interval greater than 18 months between consecutive visits. Prolonged clinical remission was defined based on SLEDAI-2K=0 (serology excluded), achieved within the first five years since diagnosis and maintained for ≥10 years. Prolonged LDA was defined as SLEDAI-2K ≤ 2 (serology excluded) for the same period. Statistical analysis was performed with SAS 9.0 software; p<0.05 was considered significant.
Results: Of the 883 inception patients, 382 fulfilled the inclusion criteria. Twenty-seven patients (7.1%) achieved prolonged clinical remission and 48 (12.6%) prolonged LDA. There were no differences regarding demographic, clinical, and immunological variables at diagnosis and at 10 years. Mean prednisone dose at diagnosis was higher in the patients who achieved remission. Antimalarial usage was higher in patients with LDA both at diagnosis and at 10 years. The two groups had comparable cumulative damage over 10 years, flare rate after 10 years, and mortality throughout follow-up. Details are given in Table 1.
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Table 1. Comparison between patients with prolonged remission and LDA |
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|
|
At diagnosis |
At 10 years |
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|
Variable |
CR (n=27) |
LDA (n=48) |
p |
CR (n=27) |
LDA (n=48) |
p |
|
Age at diagnosis (y) |
39±14.1 |
39.1±14.9 |
0.976 |
|
|
|
|
ACR criteria (mean±SD) |
4.4±1.4 |
4.9±1.7 |
0.199 |
|
|
|
|
Time to remission or LDA (y) |
1.6±1.3 |
1.8±1.6 |
0.656 |
|
|
|
|
SLEDAI-2K (mean±SD) |
10.7±11.6 |
9.5±10 |
0.642 |
1.2±1.6 |
1.6±1.7 |
0.305 |
|
Low complement (n, %) |
9 (33.3%) |
16 (33.3%) |
1.000 |
8 (29.6%) |
13 (27.1%) |
0.97 |
|
Anti-dsDNA (n, %) |
13 (48.1%) |
16 (33.3%) |
0.206 |
6 (22.2%) |
12 (25.0%) |
0.956 |
|
Glucocorticosteroids (n, %) |
17 (63.0%) |
33 (68.8%) |
0.61 |
6 (22.2%) |
10 (20.8%) |
0.888 |
|
Mean prednisone dose (mg/d) |
16.8±9.5 |
10.7±8.4 |
0.028 |
5.3 ± 3.2 |
4.6 ± 1.4 |
0.576 |
|
Cumulative prednisone dose (g) |
|
|
|
18.1 ± 12.4 |
13.4 ± 9.1 |
0.129 |
|
Antimalarials (n, %) |
16 (59.3%) |
38 (79.2%) |
0.065 |
11 (40.7%) |
32 (66.7%) |
0.029 |
|
Immunosuppressives (n, %) |
9 (33.3%) |
16 (33.3%) |
1.000 |
3 (11.1%) |
8 (16.7%) |
0.514 |
|
No Medications (n, %) |
|
|
|
12 (44.4%) |
19 (39.6%) |
0.682 |
|
SLICC/DI (mean±SD) |
0.26±0.53* |
0.33±1.04* |
0.73 |
0.96 ± 1.06 |
1.10 ± 1.32 |
0.636 |
|
Disease flare after 10 years |
|
|
|
7 (25.9%) |
15 (31.3%) |
0.627 |
|
Time to flare (median in years) |
|
|
|
12 (11-15) |
11 (10-13) |
0.217 |
|
Deceased (n, %) |
|
|
|
3 (11.1%) |
5 (10.4%) |
0.925 |
|
* At one year after diagnosis, CR: complete remission, LDA: low disease activity, SLICC/DI: Systemic Lupus International Collaborating Clinics/Damage Index |
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Conclusion: Patients with prolonged (>10 years) LDA achieved comparable outcomes as those with complete remission in the long term. Differences regarding therapeutic approach were observed but did not affect damage accumulation. Approximately 40% of these patients were able to discontinue all medications 10 years after diagnosis. Prolonged LDA status is an acceptable treat to target outcome in SLE.
To cite this abstract in AMA style:
Tselios K, Gladman DD, Touma Z, Su J, Anderson N, Urowitz M. Long-Term Outcomes in Prolonged Low Disease Activity Are Comparable to Complete Clinical Remission in Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/long-term-outcomes-in-prolonged-low-disease-activity-are-comparable-to-complete-clinical-remission-in-systemic-lupus-erythematosus/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/long-term-outcomes-in-prolonged-low-disease-activity-are-comparable-to-complete-clinical-remission-in-systemic-lupus-erythematosus/