Absence of mucocutaneous involvement, lower LDAS predict remission in SLE

Remission in patients with systemic lupus erythematosus (SLE) is predicted by the absence of mucocutaneous, renal and haematologic involvement, use of immunosuppressive drugs, and lower disease activity state (LDAS) early in the course of the disease, a study has shown. Additionally, older age predicts LDAS.

A total of 1,480 patients were included, among whom 902 were nonoptimally controlled at entry. Of these, 196 (21.7 percent) achieved remission and 314 (34.8 percent) achieved LDAS.

The following variables predicted a higher probability of remission: absence of mucocutaneous manifestations (hazard ratio [HR], 1.571, 95 percent CI, 1.064–2.320), absence of renal involvement (HR, 1.487, 1.067–2.073) and absence of haematologic involvement (HR, 1.354, 1.005–1.825); use of immunosuppressive drugs before the baseline visit (HR, 1.468, 1.025–2.105); and a lower SLE Disease Activity Index (SLEDAI) score at entry (HR, 1.028, 1.006–1.051 per 1-unit decrease).

Moreover, the predictors of LDAS included older age at entry (HR, 1.050, 1.004–1.098 per 5-year increase), absence of mucocutaneous manifestations (HR, 1.401, 1.016–1.930) and renal involvement (HR, 1.344, 1.049–1.721), and lower SLEDAI score at entry (HR, 1.025, 1.009–1.042).

The authors defined three disease activity states, as follows: remission (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 nonoptimally 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 two SLEDAI reported and not optimally controlled at entry were included the analyses. Multivariable Cox regression models (stepwise selection procedure) were used to assess remission and LDAS.