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CE-19 Remission and low lupus disease activity status (LLDAS) protect lupus patients from damage occurrence: data from a multi-ethnic, multinational latin american lupus cohort
  1. Manuel F Ugarte-Gil1,2,
  2. Daniel Wojdyla3,
  3. Guillermo J Pons-Estel4,
  4. Luis R Catoggio5,
  5. Drenkard Cristina6,
  6. Judith Sarano7,
  7. Guillermo A Berbotto8,
  8. Eduardo F Borba9,
  9. Emilia I Sato10,
  10. Joao C Tavares Brenol11,
  11. Oscar Uribe12,
  12. Luis A Ramirez12,
  13. Marlene Guibert-Toledano13,
  14. Loreto Massardo14,
  15. Mario H Cardiel15,
  16. Luis H Silveira16,
  17. Rosa Chacón-Diaz17,
  18. Graciela S Alarcón18 and
  19. Bernardo A Pons-Estel19
  1. 1Rheumatology, Hospital Guillermo Almenara Irigoyen. EsSalud, Lima, Perú
  2. 2Universidad Científica del Sur, Lima, Perú
  3. 3GLADEL consultant, Rosario, Argentina
  4. 4Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain
  5. 5Sección de Reumatología, Servicio de Clínica Médica, Hospital Italiano, Instituto Universitario Escuela de Medicina Hospital Italiano and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina
  6. 6Division of Rheumatology, Emory School of Medicine, Atlanta, USA
  7. 7Instituto de Investigaciones Médicas ‘‘Alfredo Lanari’’, Buenos Aires, Argentina
  8. 8Hospital Escuela “Eva Perón”, Granadero Baigorria
  9. 9Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
  10. 10Disciplina de Reumatología, Escola Paulista de Medicina, Universidade Federal da São Paulo -UNIFESP, São Paulo, Brazil
  11. 11Hospital das Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
  12. 12Universidad de Antioquia, Hospital Universitario “San Vicente de Paul,” Medellín, Colombia
  13. 13Centro de Investigaciones Médico Quirúrgicas- CIMEQ, Havana, Cuba
  14. 14Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
  15. 15Centro de Investigación Clínica de Morelia SC, Morelia, Michoacan, Mexico
  16. 16Instituto Nacional de Cardiología “Ignacio Chávez,” Ciudad de Mexico, Mexico
  17. 17Servicio de Reumatología, Centro Nacional de Enfermedades Reumáticas, Hospital Universitario de Caracas, Caracas, Venezuela
  18. 18Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
  19. 19Hospital Provincial de Rosario, Rosario, Argentina

Abstract

Background Recently, definitions of both Remission and LLDAS have been proposed which include disease activity status and medication intake [immunosuppressive (IS) drugs and corticosteroids]. The aim of this study was to evaluate both on the outcome of SLE patients.

Materials and methods Interval was defined as the period between two SLEDAIs or between one SLEDAI and the end of the follow-up. Four disease activity statuses were defined: Remission off-therapy = SLEDAI = 0 without prednisone or IS drugs; Remission on-therapy = SLEDAI = 0 and a prednisone dose ≤5 mg/d and/or IS drugs in maintenance dose; LLDAS = SLEDAI≤4, a prednisone dose ≤7.5 mg/d and/or IS drugs in maintenance dose; and non-optimally controlled status = SLEDAI >4 and/or prednisone dose >7.5 mg/d and/or IS drugs in induction dose. Antimalarials were allowed in all groups. Predefined outcomes were mortality, new damage [defined as an increase of at least 1 point in the SLICC/ACR damage index (SDI)] and severe new damage (defined as an increase of at least 3 points in the SDI). Univariable and multivariable Cox regression models adjusted for possible confounders were performed in order to define the impact of disease activity status, as time-dependent variable, on these three outcomes.

Results One thousand three hundred and fifty patients from the GLADEL cohort, with at least two intervals, were included, including 5672 intervals. Median length of the intervals was 7.1 months (interquartile rank 5.1–11.7). Median number of intervals per patients was 4 (2–7). The most frequent interval was non-optimally controlled (4446; 78.4%), followed by LLDAS (566; 10.0%), remission on-therapy (553; 9.7%) and remission off-therapy (107; 1.9%). Seventy-nine patients died during the follow-up, 606 presented new damage and 177 severe new damage. Because of the limited number of intervals in the off-therapy group, this group was combined with the on-therapy group. The impact of these disease activity statuses on the pre-specified outcomes is depicted in Table 1. Of importance, in multivariable analyses, remission on/off therapy was associated with both, a lower risk of new damage (HR: 0.52; 95% CI: 0.37–0.72), and of severe new damage (HR: 0.32; 95% CI: 0.15–0.65); LLDAS was associated with a lower risk of severe new damage (HR: 0.46; 95% CI: 0.23–0.91). Although the HR were in the right direction for the mortality outcome, the confidence intervals were too wide, probably because of the relative low number of events in this category.

Conclusions Remission on/off therapy diminished the risk of new and severe new damage, and LLDAS diminished the risk of severe new damage after adjusting for other well-known risk factors of damage.

View this table:
Abstract CE-19 Table 1

Impact of disease activity statuses on mortality, new damage and severe new damage. Univariable and multivariable analyses

Acknowledgements This study was performed using data from the GLADEL cohort.

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