The following article is a part of conference coverage from the American College of Rheumatology (ACR) Convergence 2021, being held virtually from November 3 to 10, 2021. The team at Rheumatology Advisor will be reporting on the latest news and research conducted by leading experts in rheumatology. Check back for more from the ACR Convergence 2021. |
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.
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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.