RT Journal Article
SR Electronic
T1 Predictors of Remission and Low Disease Activity State in Systemic Lupus Erythematosus: Data from a Multiethnic, Multinational Latin American Cohort
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 1299
OP 1308
DO 10.3899/jrheum.180433
VO 46
IS 10
A1 Manuel F. Ugarte-Gil
A1 Daniel Wojdyla
A1 Guillermo J. Pons-Estel
A1 Rosana Quintana
A1 José A. Gómez-Puerta
A1 Luis J. Catoggio
A1 Alejandro Alvarellos
A1 Verónica Saurit
A1 Eduardo Borba
A1 Emilia Sato
A1 Lilian Costallat
A1 Nilzio A. Da Silva
A1 Antonio Iglesias-Gamarra
A1 Oscar Neira
A1 Gil Reyes-Llerena
A1 Mario H. Cardiel
A1 Mary Carmen Amigo
A1 Eduardo Acevedo-Vásquez
A1 María H. Esteva-Spinetti
A1 Graciela S. Alarcón
A1 Bernardo A. Pons-Estel
YR 2019
UL http://www.jrheum.org/content/46/10/1299.abstract
AB 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.