Background Serologically active clinically quiescent (SACQ) is a clinical state of systemic lupus erythematosus (SLE) characterized by high levels of serologic markers without clinical activity. The outcome and treatment strategy after SACQ achievement remains unclear. After achieving the treatment goal, maintaining low-dose glucocorticoids has always been both a blessing and a curse.1 2 In this multi-center prospective study, we aimed to identify the risk of flares, organ damage accumulation, and the glucocorticoids discontinuation feasibility of SLE patients who achieved the clinical state as SACQ.
Methods This study was conducted based on data from the Chinese SLE treatment and research (CSTAR) registry. Demographic characteristics, autoantibody profiles, clinical manifestations, organ damage, and treatment profile were collected at recruitment and during follow-up. SACQ was defined as persistent serologic activity (positive anti-dsDNA antibody, and/or hypocomplementemia), and without clinical activity. Serologically quiescent clinically quiescent (SQCQ) was defined as a persistent serologic and clinical quiescent stage. Organ damage is principally assessed using the SLICC damage index (SDI).
Results Of 4107 SLE patients, 1889 reached the clinical quiescent stage (990 achieved SACQ, and 899 achieved SQCQ). Among SACQ patients, 364 (36.7%) underwent flares, 163(16.5%) showed organ damage, 47 (4.7%) developed renal damage, and 21 (2.1%) died during a mean follow-up of 7.30 years. Compared with SQCQ, SACQ patients were at a higher risk of flares (HR=1.47, 95% CI 1.25–1.73, p<0.001) and renal damage accumulation (HR=2.02, 95% CI 1.23–3.33, p=0.004). Furthermore, 224 (22.6%) SACQ patients withdraw glucocorticoids and 125 (55.8%) of them did not flare. Glucocorticoids discontinuation was a favorable factor of survival (HR=0.22, 85% CI, 0.05–0.96, P=0.044). As shown in the figure, withdrawing glucocorticoids can reduce organ damage (p=0.0075), especially renal damage accumulation (p=0.045), even experience flares after discontinuation.
Conclusions Glucocorticoids withdrawal under tight survallance could be considered after achieving the clinical state as SACQ to prevent the accrual of renal damage.
Apostolopoulos D, et al. The Lancet Rheumatology 2020;2(1):e24-e30.
Mathian A, et al. Ann Rheum Dis 2020;79(3):339–46.
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