Major determinants of prolonged remission in systemic lupus erythematosus: retrospective study over a 41+ year period

Area of Science:

• Rheumatology
• Immunology
• Clinical Medicine

Background:

• Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with variable clinical manifestations and outcomes.
• Achieving and sustaining remission is a key treatment goal in SLE management.
• Predictors of sustained complete remission (CR) in SLE require further investigation to optimize patient care.

Purpose of the Study:

• To identify predictors associated with achieving and sustaining complete remission (CR) for at least 3 or 5 years in patients with SLE.
• To evaluate the impact of sustained remission on patient survival rates.

Main Methods:

• Retrospective observational study of 564 SLE patients attending a tertiary hospital lupus clinic (1978-2019).
• Patients classified into complete remission (CR), serologically active clinically quiescent (SACQ), and serological remission (SR) using BILAG scores and serological profiles.
• Multivariable Cox regression and Kaplan-Meier analyses were employed to determine predictors of CR and survival.

Main Results:

• 15% of patients achieved CR, with 73% sustaining it for 5+ years. 63% achieved no remission.
• Patients achieving no remission had significantly higher early mortality rates compared to CR patients.
• Significant predictors for CR included White ethnicity (HR 2.16), older age at diagnosis >32 years (HR 1.92), absence of renal involvement (HR 2.55), and absence of antiphospholipid syndrome (APS) (HR 4.92).

Conclusions:

• Failure to achieve sustained remission in SLE is associated with increased risk of early mortality.
• White ethnicity, older age at diagnosis, and the absence of renal involvement and APS are significant predictors of CR in SLE.
• The identified predictors for sustained CR remain consistent whether a 3-year or 5-year remission period is considered.