Background/Purpose:

Developing definition(s) of remission in SLE is one of the primary recommendations on the research agenda of the treat-to-taget international task force. Definitions of remission were agreed upon by an international task force of the EULAR working group. We applied these definitions to a large clinical cohort to determine, time to remission, durability and predictors of remission.

Methods:

1555 patients with disease activity at cohort entry were followed until their first remission. 740 (48%) achieved remission.  Of those who did not achieve remission, the median follow-up was 2.6 years. Remission was defined as clinical Systemic Lupus Disease Activity Index (SLEDAI) = 0, Physician Global Assessment (PGA) ² 0.5, prednisone ² 5 mg per day and no other immunosuppressants. Remission on treatment (ROT) was defined as SLEDAI = 0, PGA ² 0.5, prednisone ² 5 mg per day and allowance for immunosuppressive drugs. Hydroxychloroquine was allowed for remission and ROT. The Kaplan-Meier approach was used to estimate the time to remission. In addition, for patients on treatment, we identified variables that were predictive of remission at the next two visits.

Results:

Median time to remission was 2.8 years in women and 5.7 in men, median time to ROT was 1.3 years in women and 2.1 in men. Of those who satisfied the definition of remission, 52% had a relapse at a clinic visit within the next 90 days, and 15% more had a relapse from 90 to 180 days post remission (see table 1). Only 16% had a remission lasting over one year and only 2% over five years. Considering patients treated with immunosuppressives or prednisone greater than 5 mg/day at one visit, 2.8% successfully tapered treatment and achieved remission over the next two visits. Table 2 below shows rates of remission in various subgroups.

Conclusion:

50% of women and men with SLE achieve remission within 2.8 years and 5.7 years, respectively. However, most of them experience a relapse within the next 90 days. This reflects the relapsing-remitting nature of SLE for many patients. Remission and remisson on treatment are frequent in SLE. Durable remission is rare. Only 16% will have durability of more than one year. African-American ethnicity, anti-dsDNA and low complement predict against achieving remission. Our results provide further insights into the nature of remission in SLE and contribute towards applying the treat-to-target principle to SLE.

Table 1: Estimates of the distribution of duration of remission.

Table 2: Proportion of patients with treatment at one visit (i.e. immunosuppressives or prednisone greater than 5) who taper treatment at the next visit and satisfy the definition of remission at a third visit.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/application-of-new-eular-definitions-of-remission-in-sle-durable-1-year-remission-is-rare/