Abstract
Objective This study aimed to determine the impact of glucocorticoid (GC) usage patterns within the first year of diagnosis on achieving prolonged remission in patients with systemic lupus erythematosus (SLE).
Methods We conducted an observational study of routine clinical care data of the Lupus Cruces-Bordeaux cohort including those patients with an SLEDAI-2K>4 at diagnosis. Prolonged remission was defined as remission (according to DORIS criteria) achieved within the first year and maintained in five consecutive yearly visits. Clusters of GC usage in the first year of diagnosis were determined, considering the maximum prednisone dosage, cumulative dosage, number of methylprednisolone pulses and the maximum pulse dosage. Hierarchical and k-means clustering techniques were employed for this purpose. Subsequently, binary logistic regression was used to obtain a propensity score for belonging to one of these clusters, incorporating critical clinical and laboratory variables that might influence the choice of one GC usage patterns over another. Propensity score matching was performed, ensuring a 1:1 ratio with a caliper of 0.2. Variables effect sizes in both groups were assessed using standardized difference measures. Generalized linear models were used to determine the association between GC usage patterns and prolonged remission, adjusted for other covariables and treatments.
Results Out of 233 patients in the full cohort. 125 patients with an SLEDAI-2K>4 at diagnosis were selected. Two patterns of GC use were identified, and 33 patients were analyzed in each of them after propensity score matching was performed. Our analysis revealed that a GC usage pattern characterized by a lower cumulative prednisone dosage, reduced maximum prednisone dosage and a higher number of methylprednisolone pulses was associated with an increased likelihood of achieving prolonged remission. The results are presented in detail within table 1 and figure 1.
Conclusions This study underscores the significant impact of early GC management patterns in achieving prolonged remission among SLE patients. Identifying clusters of GC usage provides insights into optimizing treatment strategies and promoting sustained remission. The findings emphasize the importance of tailored GC regimens to improve long-term outcomes in SLE patients.
Acknowledgements Dr. Ruiz-Irastorza was supported by the Department of Education of the Basque Government, research grant IT 1512–22. Dr. Hernandez-Negrin was supported by Consejería de Transformación Económica, Industria, Conocimiento y Universidades. Junta de Andalucía-Sevilla (Spain), research grant PREDOC-00826.
Forest plot: impact of glucocorticoid pattern on prolonged SLE remission
