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Abstract
Objectives To analyse the effect of methyl-prednisolone pulses (MP) in achieving prolonged remission in patients with systemic lupus erythematosus (SLE) according to the degree of activity at presentation.
Methods Observational study of routine clinical care data from the Lupus Cruces-Bordeaux cohort. The endpoint was prolonged remission, defined according DORIS criteria during 5 consecutive annual visits. The effect of MP on remission during the first year was analysed in the whole cohort and according to the baseline SLEDAI-2K activity score: <6 (mild), 6–12 (moderate) and >12 (severe). The individual propensity score (PS) of being treated with MP within the first year was calculated for each patient. In the multivariant logistic regression model, the PS and other therapeutic covariates were used for adjustment.
Results Two hundred and thirty-three patients were included. Prolonged remission was achieved in 132 (57%) patients (80/114, 70% in those with mild; 45/93 48% in those with moderate and 7/26, 27% in those with severe activity). The use of MP was associated with the achievement of prolonged remission (PS-adjusted OR 2.50, 95%CI 1.04–6.23, p=0.042). A meaningful effect was seen in patients with moderate (OR 5.28, 95%CI 1.27–21.97, p=0.022) and with moderate-to-severe SLE activity (OR 4.07, 95%CI 1.11–14.82, p=0.033). The use of MP resulted in lower average prednisone doses during the first year in patients with moderate (mean 6.6 vs. 10.2 mg/d, p=0.017) and severe (mean 14.5 vs. 28 mg/d, p=0.015) activity, confirmed after adjusting for PS (table 1). Longer use of hydroxychloroquine (HCQ) increased the odds of achieving prolonged remission in the whole cohort (PS-adjusted OR 1.04, 95%CI 1.01–1.07, p=0.004) and in the mild, moderate and moderate-to-severe activity subgroups. In contrast, higher initial doses of prednisone decreased the achievement of prolonged remission in either the whole cohort (PS-adjusted OR 0.96, 95%CI 0.93–0.98, p<0.001) or in the moderate or moderate-to-severe activity subgroups.
Conclusions This study supports the use of MP to induce prolonged remission in patients with moderate-to-severe SLE activity. Treatment with MP also resulted in a reduced prednisone load. The extended use of HCQ and lower initial doses of prednisone also contributed to the achievement of prolonged remission.
Predictors of prolonged remission propensity score-adjusted in the whole cohort and by SLEDAI groups
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