Predictors of remission and low disease activity state in systemic lupus erythematosus: Data from a multiethnic, multinational Latin American cohort

M. F. Ugarte-Gil, D. Wojdyla, G. J. Pons-Estel, R. Quintana, J. A. Gómez-Puerta, L. J. Catoggio, A. Alvarellos, V. Saurit, E. Borba, E. Sato, L. Costallat, N. A. da Silva, A. Iglesias-Gamarra, O. Neira, G. Reyes-Llerena, M. H. Cardiel, M. C. Amigo, E. Acevedo-Vásquez, M. H. Esteva-Spinetti, G. S. AlarcónB. A. Pons-Estel

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)1299-1308
Number of pages10
JournalJournal of Rheumatology
Volume46
Issue number10
DOIs
StatePublished - 2019

Bibliographical note

Funding Information:
We are grateful to Daniel Villalba and Leonardo Grasso for assistance with the ARTHROS software. The GLADEL group acknowledges PANLAR (Pan American League of Associations for Rheumatology) for its support of the SLE study group.

Publisher Copyright:
The Journal of Rheumatology Copyright © 2019. All rights reserved.

Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.

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