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  • P141 Effect of remission, clinical remission with active serology, and glucocorticoid dosage on the pregnancy outcome of pregnant patients with systemic lupus erythematosus

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P141 Effect of remission, clinical remission with active serology, and glucocorticoid dosage on the pregnancy outcome of pregnant patients with systemic lupus erythematosus
  1. Takehiro Nakai1,
  2. Nanase Honda2,
  3. Eri Soga3,
  4. Sho Fukui1,4,5,
  5. Ayako Kitada1,6,
  6. Naoto Yokogawa2 and
  7. Masato Okada1
  1. 1Immuno-Rheumatology Center, St. Luke’s International Hospital, Tokyo, Japan
  2. 2Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
  3. 3Department of Obstetrics and Gynecology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
  4. 4Department of General Medicine, Kyorin University School of Medicine, Tokyo, Japan
  5. 5Section of clinical science, Division of Rheumatology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
  6. 6Department of Rheumatology, Institute of Medicine, University of Tsukuba, Ibaraki, Japan

Abstract

Background Remission is a key treatment target in systemic lupus erythematosus (SLE) management. Given the direct correlation between lupus flares and elevated risks of adverse pregnancy outcomes (APOs), securing remission before conception becomes crucial. However, the association between clinical remission with active serology, and the risk of APOs is not thoroughly understood. Additionally, determining the optimal glucocorticoid dosage during pregnancy to mitigate APO risks remains under-researched. This study investigated the risk of APOs in relation to remission/serological activity status in patients in clinical remission/glucocorticoid dosage.

Methods Pregnant patients with SLE, who were followed up at two Japanese tertiary referral centers, and had their remission status assessed at conception, were included in this study. We categorized the patients into two groups based on whether they achieved Zen/Doria remission at conception and analyzed the APO ratio. We also examined the influence of serological activity in pregnant patients with clinical remission and analyzed the optimal glucocorticoid dosage to minimize the APO ratio.

Results Of the 96 pregnancies included, 59 achieved remission at conception. Pregnant patients who achieved remission showed a significant decrease in the APO ratio compared with those who did not. (overall APO: odds ratio (OR) 0.27, 95% confidence interval (CI) 0.11–0.65, p<0.01, maternal APO: OR 0.34, 95%CI 0.13–0.85, p=0.021, neonatal APO: OR 0.39, 95%CI 0.17–0.90, p=0.028, table 1). Conversely, no statistical difference was observed in the APO ratio based on serological activity in pregnant patients with clinical remission. (overall APO: OR 0.62, 95%CI 0.21–1.79, p=0.37, maternal APO: OR 1.25, 95%CI 0.32–4.85, p=0.75, neonatal APO: OR 0.83, 95%CI 0.29–2.39, p=0.73, table 2). A glucocorticoid dose of prednisolone equivalent ≥7.5 mg/day at conception correlated with increased APO. (overall APO: OR 3.01, 95%CI 1.23–7.39, p=0.016, neonatal APO: OR 2.98, 95% CI:1.23–7.22, p=0.016, table 3).

Conclusions Even with active serology, achieving clinical remission can be a clinical target for reducing APOs in patients who wish to conceive. In addition, if clinically feasible, reducing the glucocorticoid dosage to <7.5 mg/day before conception could be another treatment target.

View this table:
Abstract P141 Table 1

Adverse pregnancy outcome ratio according to the achievement of remission at conception

View this table:
Abstract P141 Table 2

APO ratio in pregnant patients in clinical remission at conception based on the serological activity

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Abstract P141 Table 3

Glucocorticoid dosage (prednisolone equivalent) >7.5 mg/day at conception and risk of APO

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/lupus-2024-el.195

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