Date: Monday, November 8, 2021
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.
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 10). 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 January 27, 2022.
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