ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1272

Impact of Remission and Low Disease Activity Status on Hospitalizations Among SLE Patients from the GLADEL Latin American Cohort

Guillermo Pons-Estel1, Manuel Ugarte-Gil2, Guillermina Harvey3, Daniel Wojdyla4, Rosana Quintana1, Rosa Serrano-Morales1, José Gómez-Puerta5, Mercedes García6, Luis Catoggio7, Verónica Saurit8, Cristina Drenkard9, Nilzio Antonio Da Silva10, Fernando Cavalcanti11, Eduardo Borba12, Emilia Sato13, Oscar Neira14, Loreto Massardo15, Gloria Vásquez16, Luis Alonso Gonzalez17, Marlene Guibert Toledan18, Luis Silveira19, Ignacio García De La Torre20, María Josefina Sauza del Pozo21, Rosa Chacón22, Mario Cardiel23, Graciela Alarcón24 and Bernardo Pons-Estel25, 1Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina, 2Servicio de Reumatología. Hospital Nacional Guillermo Almenara Irigoyen and Universidad Científica del Sur, Lima, Peru, 3Guillermina Escuela de Estadística, Facultad de Ciencias Económicas y Estadística, Universidad Nacional de Rosario, Rosario, Argentina, 4GLADEL consultant, Rosario, Argentina, 5Servicio de Reumatología, Hospital Clinic., Barcelona, Spain, 6Servicio de Reumatología del HIGA San Martin de La Plata, La Plata, Argentina, 7Rheumatology Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 8Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Cordoba, Argentina, 9Division of Rheumatology, Department of Medicine, Emory School of Medicine, Atlanta, GA, 10Reumatologia/Departamento de Clínica Médica, Hospital das Clínicas, Universidade Federal de Goiás, Goias, Brazil, 11Serviço de Reumatologia, Departamento de Medicina Clínica, Centro de Ciências Médicas, Hospital das Clínicas, Universidade Federal de Pernambuco, Pernambuco, Brazil, 12Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil, 13Escola Paulista de Medicina, Universidad Federal São Paulo, São Paulo, Brazil, 14Sección de Reumatología, Hospital del Salvador, Universidad de Chile, Santiago, Chile, 15Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile, 16Grupo de Inmunología Celular e Inmunogenética, Facultad de Medicina, Universidad de Antioquía, Medellín, Colombia, 17Sección de Reumatología, Departamento de Medicina Interna, Universidad de Antioquía, Medellín, Colombia, 18Marlene Centro de Investigaciones Médicas Quirúrgicas, Havana, Cuba, 19Departamento de Inmunología / Departamento de Reumatología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico, 20Departamento de Inmunología y Reumatología, Hospital General de Occidente de la S.S. y Universidad de Guadalajara, Jalisco, Mexico, 21Instituto Mexicano de Seguro Social, Hospital de Especialidades Nº 25, Monterrey, Mexico, 22Servicio de Reumatología, Policlínica Méndez Gimón, Caracas, Venezuela, 23Centro de Investigación Clínica de Morelia, Morelia, Mexico, 24Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, The University of Alabama at Birmingham; Department of Medicine, School of Medicine; Universidad Peruana Cayetano, Heredia, Alabama, 25Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Santa Fe, Argentina

Meeting: ACR Convergence 2020

Keywords:

Session Information

Date: Sunday, November 8, 2020

Title: SLE – Diagnosis, Manifestations, & Outcomes Poster II: Comorbidities

Session Type: Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: To determine whether remission and low disease activity state (LDAS) reduce hospitalizations in systemic lupus erythematosus (SLE) patients.

Methods: A multi-ethnic, multi-national Latin-American SLE cohort was studied.

Visits were performed every six months. Variables were ascertained at each visit. The first hospitalization following cohort entry was evaluated in the interval between two visits. Based on the definitions of remission in SLE (DORIS) framework, for each visit remission on treatment was defined as a SLEDAI of 0, prednisone ≤5 mg/day and maintenance treatment with immunosuppressants. LDAS was defined as a SLEDAI ≤4 with no SLEDAI scores for renal, central nervous system, serositis, vasculitis, and constitutional components, no increase in any SLEDAI component since the previous visit, and prednisone dose ≤7.5 mg/day. Immunosuppressants at maintenance doses were allowed for LDAS. Antimalarial treatment was allowed for both states. Potential confounders of hospitalization included sociodemographic factors, baseline damage (Systemic Lupus International Collaborating Clinics Damage Index or SDI), previous hospitalizations, glucocorticoids and antimalarials (users and non-users). Both, disease activity status and antimalarials were evaluated as time-dependent covariates. Cox regression model was used to evaluate whether remission on treatment and LDAS protected against hospitalizations after controlling for important confounders. A multivariable model was built by selecting covariates using a backward elimination procedure.

Results: One thousand three hundred and forty-one patients were included; 1201 (89.6%) were female. The median (IQR) age at diagnosis was 27 (20-37) years and the median (IQR) follow up time 27.5 (4.7-62.2) months. A total of 508 patients were hospitalized, of those 455 (89.6%) were female.

There were 6,089 intervals for these 1,341 patients. The median number of intervals per patient was 4 (2-7), and the median length of the intervals was 7.1 (5.1-11.7) months. Of the intervals examined, the most frequent status was non-optimally controlled, with 4,269 (75.1%) intervals, followed by remission on treatment 772 (13.6%) and LDAS 643 (11.3%) intervals. In the multivariable analysis, remission on treatment (HR 0.46; 95% CI 0.29–0.72) but not LDAS was found to decrease the hazard ratio of hospitalization, after adjusting for confounders. Of interest, antimalarials were found to be protective (HR: 0.61; 95% CI 0.51-0.72).

Conclusion: In this large Latin American multiethnic, multinational lupus cohort, remission on treatment reduced the risk of hospitalization after adjusting for other well-known risk factors. It is worth pointing out that antimalarial use seemed to protect against the occurrence of hospitalizations, supporting its role as a cornerstone treatment in SLE. Our findings call for seeking remission as a fundamental target in the management of patients with SLE.

Acknowledgments: The authors are grateful to Jennifer H Lofland, Federico Zazzetti, and Chetan Karyekar for their contributions.

Table 1: Impact of disease activity status on hospitalization: univariable and multivariable analyses. LDAS: low disease activity status; ALA: Afro-Latin American; SDI: SLICC/ACR damage index; HR: Hazard ratio; 95% CI: 95% confidence interval; Ref: reference group

Disclosure: G. Pons-Estel, None; M. Ugarte-Gil, Janssen, 2, Pfizer, 2; G. Harvey, None; D. Wojdyla, None; R. Quintana, None; R. Serrano-Morales, None; J. Gómez-Puerta, Abbvie, 8, BMS, 8, GSK, 8, Janssen, 8, MSD, 8, Pfizer, 8, Roche, 5, 8; M. García, None; L. Catoggio, None; V. Saurit, None; C. Drenkard, None; N. Da Silva, None; F. Cavalcanti, None; E. Borba, None; E. Sato, None; O. Neira, None; L. Massardo, None; G. Vásquez, None; L. Alonso Gonzalez, None; M. Guibert Toledan, None; L. Silveira, None; I. García De La Torre, None; M. Sauza del Pozo, None; R. Chacón, None; M. Cardiel, None; G. Alarcón, None; B. Pons-Estel, None.

To cite this abstract in AMA style:

Pons-Estel G, Ugarte-Gil M, Harvey G, Wojdyla D, Quintana R, Serrano-Morales R, Gómez-Puerta J, García M, Catoggio L, Saurit V, Drenkard C, Da Silva N, Cavalcanti F, Borba E, Sato E, Neira O, Massardo L, Vásquez G, Alonso Gonzalez L, Guibert Toledan M, Silveira L, García De La Torre I, Sauza del Pozo M, Chacón R, Cardiel M, Alarcón G, Pons-Estel B. Impact of Remission and Low Disease Activity Status on Hospitalizations Among SLE Patients from the GLADEL Latin American Cohort [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/impact-of-remission-and-low-disease-activity-status-on-hospitalizations-among-sle-patients-from-the-gladel-latin-american-cohort/. Accessed .

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