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Abstract
Background SLE is a difVcult to treat autoimmune disease due to clinical heterogeneity, unpredictability of disease iares and limited therapeutics. These challenges are worsened in a low-middle income country (LMIC) setting, yet clinical epidemiology from LMIC may have global beneVts.
Objectives To determine (i) the clinical pattern of SLE and (ii) the effect of SLE severity and treatment regimen on time to remission.
Methods A retrospective cohort study of 200 SLE patients’ medical records (2014–20) from ImmunoCure clinic was conducted. Patients fulVlled ACR criteria 1997 for SLE classiVcation. SLEDAI-2K categories were used as outcome measure: mild (score <=6), moderate (7–10), severe (>10) to evaluate clinical pattern of SLE. Statistical analyses were performed using STATA v16.0. Kruskal-Wallis test was used for continuous measures, and Pearson’s chi square test was used to compare categorical variables across SLEDAI severity. Remission status based on DORIS criteria and time to remission (>1year; n=94) was the secondary outcome.
Total doses of all drugs were calculated. Survival regression performed with Kaplan Meier curve.
Results Most frequent antibodies are anti-dsDNA (63%), SSA (24%) and Ku (17.5%). Anti-cardiolipin (aCL) antibodies associate with severe SLE (OR = 3.6, P<0.01). Most common presentations were arthritis (85%), alopecia (53%), anemia (38%), rash (35%) and CNS disease (28%). Nephritis, CNS disease, cytopenias and oral ulcers are signiVcantly associated with severe SLE (P<0.01). ILD is in 10% of our cohort. Frequency of severe SLE was 47.5%, whereas mild disease was 16.5%. Mean duration of follow up was 41±19 months.
Every month of follow-up increased the odds of remission by 6% (P<0.05). Clinical remission on treatment (at Pred<=5mg) was successfully achieved in 62% patients. Complete remission (off all drugs & Pred) was achieved in 24 patients (14 in severe SLEDAI category) out of 200, with a mean post remission follow-up of 18 ± 15 months.. Hazard of time to remission is 61% (CI: 0.21–0.77, P=0.01) less in severe SLE as compared to mild SLE disease activity (Figure 1).
Conclusion Sustained remission is possible even in severe SLE in a LMIC setting if adequate immunosuppression is provided with persistent clinical follow-up.
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