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Predictors of Remission and Low Disease Activity State in Systemic Lupus Erythematosus: Data from a Multiethnic,
Manuel F Ugarte-Gil1,2, Daniel Wojdyla3,4, Guillermo J Pons-Estel3,4
1From the Department of Rheumatology, Hospital Guillermo Almenara Irigoyen, EsSalud; Universidad Científica del Sur, Lima, Peru; Grupo Latino Americano De Estudio de Lupus (GLADEL), Rosario, Argentina; Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain; Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Grupo Oroño, Sanatorio Parque, Rosario, Santa Fe, Argentina; Servicio de Reumatología, Hospital Clinic, Barcelona, Spain; Sección de Reumatología, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Instituto Universitario, Escuela de Medicina Hospital Italiano and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires; Servicio de Reumatología, Hospital Privado, Centro Medico de Córdoba, Córdoba, Argentina; Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo; Disciplina de Reumatologia, Escola Paulista de Medicina/UNIFESP, Hospital São Paulo, Universidade Federal de São Paulo, São Paulo; Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas; Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, Brazil; Clínica Saludcoop 104 Jorge Piñeros Corpas and Hospital San Juan de Dios, Universidad Nacional de Colombia, Bogotá, Colombia; Hospital del Salvador, Facultad de Medicina, Universidad de Chile, Santiago, Chile; Servicio de Reumatología, Centro de Investigaciones Médico Quirúrgicas-CIMEQ, Havana, Cuba; Centro de Investigación Clínica de Morelia SC, Morelia, Michoacán; Reumatología, Centro Médico ABC, Ciudad de México, México; Universidad Nacional Mayor de San Marcos, Lima, Peru; Hospital Central de San Cristóbal, San Cristóbal, Venezuela; Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. manuel_ugarte@yahoo.com.
Objective:
To determine the predictors of remission and low disease activity state (LDAS) in patients with systemic lupus erythematosus (SLE).
Methods:
Three disease activity states were defined: Remission = SLE Disease Activity Index (SLEDAI) = 0 and prednisone ≤ 5 mg/day and/or immunosuppressants (maintenance dose); LDAS = SLEDAI ≤ 4, prednisone ≤ 7.5 mg/day and/or immunosuppressants (maintenance dose); and non-optimally controlled state = SLEDAI > 4 and/or prednisone > 7.5 mg/day and/or immunosuppressants (induction dose). Antimalarials were allowed in all groups. Patients with at least 2 SLEDAI reported and not optimally controlled at entry were included in these analyses. Outcomes were remission and LDAS. Multivariable Cox regression models (stepwise selection procedure) were performed for remission and for LDAS.
Results:
Of 1480 patients, 902 were non-optimally controlled at entry; among them, 196 patients achieved remission (21.7%) and 314 achieved LDAS (34.8%). Variables predictive of a higher probability of remission were the absence of mucocutaneous manifestations (HR 1.571, 95% CI 1.064-2.320), absence of renal involvement (HR 1.487, 95% CI 1.067-2.073), and absence of hematologic involvement (HR 1.354, 95% CI 1.005-1.825); the use of immunosuppressive drugs before the baseline visit (HR 1.468, 95% CI 1.025-2.105); and a lower SLEDAI score at entry (HR 1.028, 95% CI 1.006-1.051 per 1-unit decrease). These variables were predictive of LDAS: older age at entry, per 5-year increase (HR 1.050, 95% CI 1.004-1.098); absence of mucocutaneous manifestations (HR 1.401, 95% CI 1.016-1.930) and renal involvement (HR 1.344, 95% CI 1.049-1.721); and lower SLEDAI score at entry (HR 1.025, 95% CI 1.009-1.042).
Conclusion:
Absence of mucocutaneous, renal, and hematologic involvement, use of immunosuppressive drugs, and lower disease activity early in the course of the disease were predictive of remission in patients with SLE; older age was predictive of LDAS.
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