Background Remission is the ultimate goal in SLE. In this study, we applied four definitions of remission agreed on by an international collaboration (DORIS) to a large clinical cohort.

Materials and methods We applied the DORIS definitions of Clinical Remission, Complete Remission (requiring negative serologies), Clinical Remission on Treatment (ROT) and Complete ROT. 2307 patients entered the cohort from 1987 to 2014. Patients not in remission at cohort entry were followed prospectively. We used the Kaplan-Meier approach. Cox regression was used to identify baseline factors associated with time to remission

Results The median time to remission was 8.7, 11.0, 1.8 and 3.1 years for Clinical Remission, Complete Remission, Clinical ROT and Complete ROT, respectively. High baseline treatment was the major predictor of a longer time to remission, followed by high baseline activity. The median duration of remission for all definitions was just three months. Based on Kaplan-Meier estimates, we determined the durability of remission by specified times as shown in Table 1. African-American ethnicity, baseline low C3 and baseline hematologic activity were associated with longer time to remission for all definitions. Baseline anti-dsDNA and baseline low C4 were associated with longer time to Complete Remission and Complete ROT. Baseline low C4 was also a negative predictor for Clinical Remission.

Conclusions These findings demonstrate that it was easier to reach ROT than remission. Baseline treatment and baseline disease activity were strongly associated with the time to remission for all definitions. We found that the durability of remission was very short, regardless of definition. African-American ethnicity, baseline low C3 and baseline hematologic activity were associated with a longer time to remission. Baseline anti-dsDNA and baseline low C4 were negative predictors for complete remission and for complete ROT. Our results provide further insights into the frequency and durability of remission in SLE and call attention to the major role of baseline activity and baseline treatment in predicting remission.