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Abstract
Background Remission and LLDAS have been proposed as the treatment goal for SLE patients. Different investigators have reported that achieving these states prevent damage accrual; however, their independent impact on the occurrence of flares has been only scarcely evaluated. The aim of this study was to evaluate the independent impact of remission and LLDAS on flares.
Methods SLE patients from a single center cohort with at least two visits were included. Visits were performed every six months. Disease activity state was defined as three independent states: remission defined as a SLEDAI-2k (excluding serology) =0, physician global assessment (PGA)<0.5, prednisone daily dose≤5 mg/d and immunosuppressive drugs on maintenance dose (based on 2021 DORIS definition); LLDAS defined as a SLEDAI-2k≤4 with no activity in major organ systems, with no new features of lupus disease activity compared to the previous assessment, physician global assessment (PGA)≤1.0, prednisone daily dose≤7.5 mg/d; and the rest were defined as active. Flares were defined as an increase of at least four points in the SLEDAI-2k between two consecutive visits. Generalized estimating equations were performed, using as outcome the occurrence of a flare in the subsequent visit, and the activity state in the previous visit; multivariable models were adjusted for possible confounders [age, gender, socioeconomic status, educational level, disease duration, antimalarial use and SLICC/ACR damage index (SDI)]. All the confounders were measured in the same visit than the activity state.
Results Two hundred and eighty-one patients were included, they were followed-up for 2.7 (1.1) years. A total of 1346 visits were included, 730 (54.2%) of them were on remission, 190 (14.1%) were on LLDAS, and 426 (31.6%) were active. One hundred and one flares occurred during the follow-up among these 281 patients; 197 of them (70.1%) did not present flares, 67 (23.8%) presented one flare and 17 (6.0) presented two flares. Remission and LLDAS were associated with a lower probability of flares. Univariable and multivariable models are depicted in table 1.
Factors associated with flares. Univariable and multivariable models
Conclusions Remission and LLDAS are independently associated with a lower probability of flares. These results reinforce the importance of these states as the goals of SLE treatment.
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