Remission and Low Lupus Disease Activity Status (LLDAS) Protect Lupus Patients from Damage Occurrence: Data from a Multi-Ethnic, Multinational Latin American Lupus Cohort

Manuel Ugarte-Gil^1,2, Daniel Wojdyla³, Guillermo J. Pons-Estel⁴, Luis J. Catoggio⁵, Cristina Drenkard⁶, Judith Sarano⁷, Guillermo Berbotto⁸, Eduardo Borba⁹, Emilia Sato¹⁰, Joao Carlos Brenol¹¹, Oscar Uribe¹², Luis Ramirez¹², Marlene Guibert-Toledano¹³, Loreto Massardo¹⁴, Mario Cardiel¹⁵, Luis H. Silveira¹⁶, Rosa Chacón-Díaz¹⁷, Graciela S. Alarcón¹⁸, Bernado Pons-Estel¹⁹ and GLADEL (Grupo LatinoAmericano de Estudio de Lupus), ¹Rheumatology, Hospital Guillermo Almenara Irigoyen. EsSalud, Lima, Peru, ²Universidad Cientifica del Sur, Lima, Peru, ³GLADEL consultant, Rosario, Argentina, ⁴Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic de Barcelona, Barcelona, Spain, ⁵Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano de Buenos Aires, and Fundacion PM Catoggio, Argentina., Buenos Aires, Argentina, ⁶Emory University School of Medicine, Atlanta, GA, ⁷Instituto de Investigaciones Medicas Alfredo Lanari, Buenos Aires, Argentina, ⁸Sanatorio Británico, Rosario, Argentina, ⁹Faculdade de Medicina, Hospital das Clínicas. Universidade de São Paulo, São Paulo, Brazil, ¹⁰Rheumatology Division. Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil, ¹¹Hospital das Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre - RS, Brazil, ¹²Hospital Universitario “San Vicente de Paul”, Universidad de Antioquia, Medellín, Colombia, ¹³Rheumatology, Centro de Investigaciones Médico Quirúrgicas, Habana, Ciudad Habana, Cuba, ¹⁴Departments of Immunology & Rheumatology, Pontificia Universidad Católica de Chile, Santiago, Chile, ¹⁵Centro de Investigación Clínica de Morelia SC, Morelia, Mexico, ¹⁶Instituto Nacional de Cardiologia Ignacio Chavez, Mexico city, Mexico, ¹⁷Servicio de Reumatología, Hospital Universitario de Caracas, Centro Nacional de Enfermedades Reumáticas, Caracas, Venezuela, ¹⁸Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, ¹⁹Sanatorio Parque, Rosario, Argentina

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: outcomes, remission and systemic lupus erythematosus (SLE)

Session Information

Date: Monday, November 14, 2016

Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment - Poster II: Damage Accrual and Quality of Life

Session Type: ACR Poster Session B

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

Background/Purpose: Recently, definitions of both Remission and LLDAS have been proposed which include disease activity status and medication intake [immunosuppressive (IS) drugs and corticosteroids]. The aim of this study was to evaluate both on the outcome of SLE patients from a multinational, multi-ethnic Latin American cohort.

Methods: Interval was defined as the period between two SLEDAIs or between one SLEDAI and the end of the follow-up. Four disease activity statuses were defined: Remission off-therapy=SLEDAI=0 without prednisone or IS drugs; Remission on-therapy= SLEDAI=0 and a prednisone dose≤5mg/d and/or IS drugs in maintenance dose; LLDAS=SLEDAI≤4, a prednisone dose≤7.5mg/d and/or IS drugs in maintenance dose; and non-optimally controlled status= SLEDAI>4 and/or prednisone dose>7.5mg/d and/or IS drugs in induction dose. Antimalarials were allowed in all groups. Predefined outcomes were mortality, new damage [defined as an increase of at least 1 point in the SLICC/ACR damage index (SDI)] and severe new damage (defined as an increase of at least 3 points in the SDI). Univariable and multivariable Cox regression models adjusted for possible confounders were performed in order to define the impact of disease activity status, as time-dependent variable, on these outcomes.

Results: One thousand three hundred and fifty patients from this cohort, with at least two intervals, accounted for the 5672 intervals examined. Median length of the intervals was 7.1 months (interquartile rank 5.1-11.7). Median number of intervals per patients was 4 (2-7). The most frequent interval was non-optimally controlled (4446; 78.4%), followed by LLDAS (566; 10.0%), remission on-therapy (553; 9.7%) and remission off-therapy (107; 1.9%). Seventy-nine patients died during the follow-up, 606 presented new damage and 177 severe new damage. Because of the limited number of intervals in the off-therapy group, this group was combined with the on-therapy group. The impact of these disease activity statuses on the pre-specified outcomes is depicted in table 1. Of importance, in multivariable analyses, remission on/off therapy was associated with both, a lower risk of new damage (HR:0.52; 95%CI:0.37-0.72), and of severe new damage (HR:0.32; 95%CI:0.15-0.65); LLDAS was associated with a lower risk of severe new damage (HR:0.46; 95%CI:0.23-0.91). Although the HR were in the right direction for the mortality outcome, the confidence intervals were too wide, probably because of the relative low number of events in this category.

Conclusion: Remission on/off therapy diminished the risk of new and severe new damage, and LLDAS diminished the risk of severe new damage after adjusting for other well-known risk factors of damage.

Disclosure: M. Ugarte-Gil, None; D. Wojdyla, None; G. J. Pons-Estel, None; L. J. Catoggio, None; C. Drenkard, None; J. Sarano, None; G. Berbotto, None; E. Borba, None; E. Sato, None; J. C. Brenol, None; O. Uribe, None; L. Ramirez, None; M. Guibert-Toledano, None; L. Massardo, None; M. Cardiel, None; L. H. Silveira, None; R. Chacón-Díaz, None; G. S. Alarcón, None; B. Pons-Estel, None.

To cite this abstract in AMA style:

Ugarte-Gil M, Wojdyla D, Pons-Estel GJ, Catoggio LJ, Drenkard C, Sarano J, Berbotto G, Borba E, Sato E, Brenol JC, Uribe O, Ramirez L, Guibert-Toledano M, Massardo L, Cardiel M, Silveira LH, Chacón-Díaz R, Alarcón GS, Pons-Estel B. Remission and Low Lupus Disease Activity Status (LLDAS) Protect Lupus Patients from Damage Occurrence: Data from a Multi-Ethnic, Multinational Latin American Lupus Cohort [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/remission-and-low-lupus-disease-activity-status-lldas-protect-lupus-patients-from-damage-occurrence-data-from-a-multi-ethnic-multinational-latin-american-lupus-cohort/. Accessed .

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