ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1276

Predictors of Remission (on and off Treatment) and Lupus Low Disease Activity State (LLDAS) in Systemic Lupus Erythematosus (SLE): Data from a Multinational, Multicenter SLICC (Systemic Lupus International Collaborating Clinics) Cohort

Manuel Ugarte-Gil1, Guillermo Ruiz-Irastorza2, Dafna Gladman3, Murray Urowitz4, Ann Clarke5, John Hanly6, Caroline Gordon7, Sang-Cheol Bae8, Juanita Romero-Diaz9, Jorge Sanchez-Guerrero10, Sasha Bernatsky11, Daniel Wallace12, David Isenberg13, Anisur Rahman14, Joan Merrill15, Paul R Fortin16, Ian N. Bruce17, Michelle Petri18, Ellen Ginzler19, Mary Anne Dooley20, Rosalind Ramsey-Goldman21, Susan Manzi22, Andreas Jnsen23, Ronald F van Vollenhoven24, Cynthia Aranow25, Meggan Mackay25, S Sam Lim26, Murat Inanc27, Kenneth Kalunian28, Soren Jacobsen29, Christine Peschken30, Diane Kamen31, Anca Askanase32, Bernardo A. Pons-Estel33 and Graciela Alarcn34, 1Hospital Guillermo Almenara Irigoyen, Essalud/Universidad Científica del Sur, Lima, Peru, 2Hospital Universitario Cruces, University of the Basque Country, Bizkaia, Spain, 3Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada, 4Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto, Lupus Clinic, Toronto, ON, Canada, 5University of Calgary, Calgary, AB, Canada, 6Dalhousie University, Halifax, NS, Canada, 7Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom, 8Hanyang University Medical Center, Seoul, Republic of Korea, 9Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de México, Federal District, Mexico, 10Instituto Nacional de Ciencias Médicas y Nutrición, Inmunología y Reumatología, Mexico City, Mexico, 11McGill University, Montréal, QC, Canada, 12Cedars-Sinai, Los Angeles, CA, 13Centre for Rheumatology, University College London, London, United Kingdom, 14University College London, London, United Kingdom, 15Oklahoma Medical Research Foundation, Oklahoma City, OK, 16CHU de Quebec - Universite Laval, Québec City, QC, Canada, 17University of Manchester, Manchester, United Kingdom, 18Johns Hopkins University School of Medicine, Baltimore, MD, 19SUNY Downstate Health Sciences University, Brooklyn, NY, 20Raleigh Neurology Associates, Chapel Hill, NC, 21Northwestern University, Chicago, IL, 22Allegheny Health Network, Wexford, PA, 23Lund University, Lund, Sweden, 24Amsterdam University Medical Centers, Department of Rheumatology and Clinical Immunology, Rheumatology and Immunology Center ARC, Amsterdam, Netherlands, 25Feinstein Institutes for Medical Research, Manhasset, NY, 26Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, GA, 27Istanbul University Faculty of Medicine, Istanbul, Turkey, 28UC San Diego, La Jolla, CA, 29Rigshospitalet, Copenhagen, Denmark, 30University of Manitoba, Winnipeg, MB, Canada, 31Medical University of South Carolina, Charleston, SC, 32Columbia University Medical Center, New York, NY, 33Grupo Oroo - Centro Regional de Enfermedades Autoinmunes y Reumticas (GO-CREAR), Rosario, Argentina, 34University of Alabama at Birmingham, Birmingham, AL

Meeting: ACR Convergence 2021

Keywords: , , ,

Session Information

Date: Monday, November 8, 2021

Title: SLE – Diagnosis, Manifestations, & Outcomes Poster III: Outcomes (1257–1303)

Session Type: Poster Session C

Session Time: 8:30AM-10:30AM

Background/Purpose: Remission and LLDAS have been proposed as the goals for the treatment of SLE patients. However, the predictors of each state remain unknown. The aim of this study was to determine predictors of remission and LLDAS.

Methods: We studied patients from a long-term longitudinal multinational, multiethnic SLE inception cohort followed for a mean of 6.5 years; eligible patients were those completing at least two annual visits. Three outcomes were established: 1. Remission off treatment, defined as a SLEDAI-2K (excluding serology) =0, without prednisone (PDN) and immunosuppressive drugs (IS). 2. Remission on treatment, defined as a SLEDAI-2K (excluding serology) =0, PDN≤5 mg/d and maintenance IS drugs (based on the 2017 DORIS definition). 3. LLDAS, defined as a SLEDAI-2K≤4 with no activity in major organ systems, with no new features of lupus disease activity compared to the previous assessment, PDN≤7.5 mg/d and maintenance IS drugs (based on the Asia Pacific Lupus Consortium definition). Antimalarials were allowed in all groups. Possible predictors included were sex, age at diagnosis, ethnicity, educational level, SLEDAI-2K at cohort entry, disease duration at baseline, highest PDN dose before baseline, number of methylprednisolone (MP) IV pulses as well as mean dose per pulse before baseline. Antimalarial use and the SLICC/ACR damage index (SDI) were time-dependent covariates. Three outcome groups were defined after exclusion of patients who had already achieved the outcome at baseline. Univariable and multivariable interval-censored survival regression models for each outcome (stepwise selection procedure, including age at diagnosis and sex in all models) were used. Alternative models including SLEDAI-2K’s domains instead of the global score were performed.

Results: Remission off treatment was achieved in 367 of 1243 patients (29.5%), remission on treatment in 749 of 1185 patients (63.2%), and LLDAS in 833 of 1151 patients (72.4%). Non-Caucasian ethnicity (in particular African) as well as a higher SLEDAI-2K scores and glucocorticoid (GC) dose (oral PDN as well as MP pulses) were associated with a lower probability of achieving these states. Older age at diagnosis and antimalarial use during the follow-up period were associated with a higher probability of remission on treatment and LLDAS. Disease duration at baseline was associated with a lower probability of remission off treatment. Sex, educational level, and the SDI were not associated with any of these states. These data are summarized in Table 1. In the alternative models, the SLEDAI-2K domains associated with a lower probability of achieving at least one of the outcomes were mucocutaneous (all outcomes), renal (remission off treatment and LLDAS), fever (remission off treatment) and musculoskeletal and neurological (LLDAS).

Conclusion: Older age at diagnosis and antimalarial use during follow-up were associated with a higher probability of achieving these treatment goals; on the other hand, non-Caucasian ethnicity (in particular African), a higher SLEDAI-2K, a longer disease duration at baseline and a higher dose of GC (PDN or MP pulses) early in the course of the disease were associated with a lower probability of achieving these treatment goals.

Disclosures: M. Ugarte-Gil, Pfizer, 5, Janssen, 5; G. Ruiz-Irastorza, None; D. Gladman, AbbVie, 2, 5, Amgen, 2, 5, Eli Lilly, 2, 5, Galapagos, 2, 5, Gilead, 2, 5, Janssen, 2, 5, Novartis, 2, 5, Pfizer, 2, 5, UCB, 2, 5, Celgene, 2, 5, Bristol Myers Squibb, 2, 5; M. Urowitz, GlaxoSmithKline, 2, 5, 6, UCB, 2, Lilly, 6, AstraZeneca, 2; A. Clarke, AstraZeneca, 2, GSK, 6, BMS, 2, Exagen Diagnostics, 2; J. Hanly, None; C. Gordon, Centre for Disease Control, 2, 6, Astra-Zeneca, 2, 6, MGP, 2, 6, Sanofi, 2, 6, UCB, 2, UCB, 5, 6; S. Bae, None; J. Romero-Diaz, None; J. Sanchez-Guerrero, None; S. Bernatsky, None; D. Wallace, GlaxoSmithKline, 2, 6, Eli Lilly and Company, 2, 6, AstraZeneca, 2, 6, Aurunia, 2, 6, EMD Serono, 2; D. Isenberg, None; A. Rahman, Lilly, 6; J. Merrill, GlaxoSmithKline, 2, 5, UCB, 2, AbbVie, 2, EMD Serono, 2, Remegen, 2, Celgene/Bristol Myers Squibb, 2, AstraZeneca, 2, 5, Daiichi Sankyo, 2, Servier, 2, Immupharma, 2, Amgen, 2, Janssen, 2, Lilly, 2, Genentech, 2, Resolve, 2, Alpine, 2, Aurinia, 2, Astellas, 2, Alexion, 2, Provention, 2; P. Fortin, Lilly, 1, AbbVie, 1, AstraZeneca, 1; I. Bruce, None; M. Petri, Alexion, 1, Amgen, 1, Astrazeneca, 1, 5, Aurinia, 5, 6, Eli Lilly, 5, Emergent Biosolutions, 1, Exagen, 5, Gilead Biosciences, 2, GSK, 1, 5, IQVIA, 1, Idorsia Pharmaceuticals, 2, Janssen, 1, 5, Merck EMD Serono, 1, Momenta Pharmaceuticals, 2, PPD Development, 1, Sanofi, 2, Thermofisher, 5, UCB Pharmaceuticals, 2; E. Ginzler, None; M. Dooley, None; R. Ramsey-Goldman, None; S. Manzi, Astra Zenecs, 2, 5, Cugene, 2, Eli Lilly, 2, Exagen, 2, 5, 10, UCB, 2, GSK, 2; A. Jnsen, None; R. van Vollenhoven, Bristol-Myers Squibb, 2, 5, 6, GlaxoSmithKline, 2, 5, 6, Eli Lilly, 5, Pfizer, 2, 5, 6, Roche, 5, UCB, 2, 5, 6, AbbVie, 2, 6, AstraZeneca, 2, 6, Biogen, 2, 6, Biotest,, 2, 6, Galapagos, 2, 6, Gilead, 2, 6, Janssen, 2, 6, Sanofi, 2, 6, Servier, 2, 6, Velabio, 2, 6, BMS, 5, GSK, 5, Celgene, 2, 6; C. Aranow, GlaxoSmithKline, 2, 5; M. Mackay, None; S. Lim, Bristol Myers Squibb, 5, GlaxoSmithKline, 2, ACR, 4, AstraZeneca, 5, Pfizer, 2, UCB, 2; M. Inanc, None; K. Kalunian, Amgen, 2, AbbVie, 2, AstraZeneca, 2, Biogen, 2, Bristol Myers Squibb, 2, Eli Lilly, 2, Equillium, 2, Genentech/Roche, 2, Gilead, 2, Janssen, 2, Lupus Research, 5, Pfizer, 5, Sanford Consortium, 5, Vielabio, 2, Aurinia, 2, Alliance, 2, Nektar, 2; S. Jacobsen, None; C. Peschken, AstraZeneca, 2, GlaxoSmithKline, 2, Eli Lilly, 2; D. Kamen, None; A. Askanase, GSK, 2, 5, AstraZeneca, 1, 5, Amgen, 1, Aurinia, 2, Abbvie, 1, Pfizer, 5, Eli Lilly, 5, Idorsia, 5; B. Pons-Estel, Janssen, 5, Glaxo Smith Kline, 6; G. Alarcn, None.

To cite this abstract in AMA style:

Ugarte-Gil M, Ruiz-Irastorza G, Gladman D, Urowitz M, Clarke A, Hanly J, Gordon C, Bae S, Romero-Diaz J, Sanchez-Guerrero J, Bernatsky S, Wallace D, Isenberg D, Rahman A, Merrill J, Fortin P, Bruce I, Petri M, Ginzler E, Dooley M, Ramsey-Goldman R, Manzi S, Jnsen A, van Vollenhoven R, Aranow C, Mackay M, Lim S, Inanc M, Kalunian K, Jacobsen S, Peschken C, Kamen D, Askanase A, Pons-Estel B, Alarcn G. Predictors of Remission (on and off Treatment) and Lupus Low Disease Activity State (LLDAS) in Systemic Lupus Erythematosus (SLE): Data from a Multinational, Multicenter SLICC (Systemic Lupus International Collaborating Clinics) Cohort [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/predictors-of-remission-on-and-off-treatment-and-lupus-low-disease-activity-state-lldas-in-systemic-lupus-erythematosus-sle-data-from-a-multinational-multicenter-slicc-systemic-lupus-internat/. Accessed .

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