Predictors of Remission and Low Disease Activity Assessed in Systemic Lupus Erythematosus

In patients with systemic lupus erythematosus (SLE), older age at diagnosis and antimalarial drug use were both associated with achieving remission or lupus low disease activity state (LLDAS); being non-White, having higher disease activity at baseline, longer disease duration, and previously receiving higher doses of glucocorticoids were all associated with a lower likelihood of remission or LLDAS, according to study results presented at the American College of Rheumatology (ACR) Convergence 2021, held virtually from November 3 to 10, 2021.

Patients from a longitudinal SLE inception cohort with a mean follow-up of 6.5 years were included in the study.

The 3 outcomes included remission off treatment (SLE Disease Activity Index [SLEDAI]-2K, excluding serology=0, without prednisone and immunosuppressive drugs); remission on treatment (SLEDAI-2K, excluding serology=0, with prednisone £5 mg/day and maintenance immunosuppressive drugs); and LLDAS (SLEDAI-2K £4 with no activity in major organ systems, no new features of SLE disease activity, with prednisone £7.5 mg/day and maintenance immunosuppressive drugs).

Antimalarial use was allowed in all groups. Predictors included demographic variables, disease activity measures, and treatment-related factors. Time-dependent covariates included antimalarial use and the Systemic Lupus International Collaborating Clinics (SLICC)/ACR Damage Index (SDI).

Univariable and multivariate survival regression models for each outcome were used, as well as an alternative model that used SLEDAI-2K domains instead of the global score.

Outcomes attained included remission off treatment (n=367/1243; 29.5%), remission on treatment (n=749/1185; 63.2%), and LLDAS (n=833/1151; 72.4%). Patients were less likely to achieve these outcomes if they were non-White, had higher SLEDAI-2K scores at cohort entry, and had higher glucocorticoid doses before baseline measurement (both prednisone doses and methylprednisone pulses). Older age at diagnosis and antimalarial use during the follow-up period predicted remission on treatment and LLDAS. Patients with a longer disease duration had a lower probability of remission off treatment.

The SLEDAI-2K domains associated with a lower probability of achieving 1 or more of the outcomes were mucocutaneous, renal, fever, musculoskeletal, and neurologic, according to the alternative models.

The researchers concluded, “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 [glucocorticoids] ([prednisone] or [methylprednisone] pulses) early in the course of the disease were associated with a lower probability of achieving these treatment goals.”

Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the disclosures.

Reference

Ugarte-Gil M, Ruiz-Irastorza G, Gladman D, et al. 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. Presented at: ACR Convergence 2021; November 3-10, 2021. Abstract 1276.