Background/Purpose:  Systemic lupus erythematosus (SLE) is characterized by disease flares, alternated with periods of clinical remission. In the past years, the “treat-to-target” strategy in SLE patients has been proposed, in order to reach complete remission and prevent long-term damage accrual and mortality. Data regarding demographic, clinical and serological factors associated with complete remission have been discordant and not fully addressed, which represents the aim of the present study.

Methods:  A retrospective cohort study was performed. We included patients with SLE according to the ACR classification criteria who entered to our institution between January 2003 and December 2007, with a follow-up of at least 8 years from the time of severe activity (SLE Disease Activity Index-2000 [SLEDAI-2K] ≥ 6). Moreover, severe SLE manifestations not included in the SLEDAI-2K (hemolytic anemia, myelitis, mononeuritis multiplex, myocarditis and diffuse alveolar hemorrhage) were recorded. We studied relevant demographic, clinical and serologic factors at the beginning, at the 3rd, 6th and 12th month, and at the end of the follow-up. We defined “complete remission” as SLEDAI-2K = 0 during at least one year without any immunosuppressive treatment; prednisone 1-5 mg/day and antimalarials were allowed. Flares were defined according to the Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA)-SLEDAI criteria. Differences between groups were assessed by Student’s T test. Chi square test was used and RR was calculated along with 95% CI. Multivariate analysis was performed.

Results: 114 patients fulfilled our inclusion criteria: 107 (93.85%) were women with a mean age of 30.21±8.3 years and a follow-up period of 117.9±3.14 months. 24 patients (21.05%) achieved complete remission and 5 (4.38%) achieved prolonged remission (≥ 5 years in complete remission). After univariate analysis, the following variables were associated with complete remission: SLEDAI-2K at 3rd month of follow-up (3.09 vs 8.27, p<0.001), total number of disease flares (2.20 vs 4.48, p<0.001), initial urine protein/creatinine ratio (0.47 vs 2.26, p<0.001), proliferative nephritis (RR=0.116 CI 95% 0.016-0.826, p=0.004), lymphopenia at the end (RR=0.440 CI 95% 0.221-0.873, p=0.031) and low C3 at the beginning of the follow-up (RR=0.36 CI 95% 0.167-0.772, p=0.01), treatment with azathioprine (RR=0.353 CI 95% 0.175-0.714, p=0.018) and mycophenolic acid (RR=0.072 CI 95% 0.010-0.513, p<0.001), and articular activity (RR=2.471 CI 95% 1.151-5.305, p=0.021). The variables that remained associated with complete remission after multivariate analysis were SLEDAI-2K at 3rd month of follow-up (RR=0.851 CI 95% 0.737-0.984, p=0.029) and total number of disease flares (RR=0.735, CI 95% 0.563-0.959, p=0.024).

Conclusion:  Twenty-one percent of our patients achieved a complete remission. SLEDAI-2K at 3rd month of follow-up and total number of disease flares over the patients’ disease course were independently associated with complete remission. Our findings are clinically relevant to encourage an aggressive immunosuppressive treatment and close monitoring at early stages of the disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-associated-with-complete-remission-in-patients-with-systemic-lupus-erythematosus-a-retrospective-cohort-study-in-one-center/