RT Journal Article
SR Electronic
T1 P73 Predictors of flares after glucocorticoid discontinuation in remitted patients with SLE
JF Lupus Science & Medicine
JO Lupus Sci Med
FD Lupus Foundation of America
SP A96
OP A96
DO 10.1136/lupus-2024-el.127
VO 11
IS Suppl 1
A1 Vesentini, Filippo
A1 Arru, Federico
A1 Somma, Rosanna
A1 Merra, Noemi
A1 Cadore, Cristina
A1 Gennaio, Ilenia
A1 Cruciani, Claudio
A1 Iaccarino, Luca
A1 Zen, Margherita
A1 Doria, Andrea
YR 2024
UL http://lupus.bmj.com/content/11/Suppl_1/A96.1.abstract
AB Objective Data on the safety and feasibility of the discontinuation glucocorticoids (GCs) in remitted patients with SLE are scanty and controversial results have been published. Our aim was to assess the predictors of flares after GCs discontinuation in a large cohort of prospectively followed patients.Methods Patients diagnosed after 1980 and followed-up until 2023 who achieved remission lasting at least 6 months at least once during their disease course were included. Remission was defined as clinical SLEDAI-2K=0 on a stable immunosuppressive and/or antimalarial therapy and/or prednisone ≤5 mg/day. Flares were defined as any increase in clinical SLEDAI-2K>0 or the need for changes in SLE medications. Remitted patients who flared after discontinuing GCs were compared with patients who did not flare. Logistic regression was used to identify predictors of flare and Cox-regression to identify predictors of flare-free survival. Results Prospectively collected data from 484 patients who achieved remission at least once during follow-up were retrospectively analysed. Three-hundred-eighty patients achieved remission off-GCs and were analysed. During a mean observational time of 87 (±76) months, 48 flares were observed, meaning an annual flare rate of1.65 flare/100 patients/year. At multivariate logistic regression analysis, predictors of flares after GC withdrawal were low C3 levels (OR 0.007, CI 95% 0.00–0.188, p=0.007), arthritis (3.108, 1.096–8.811, p=0.033), leukopenia (2.146, 1.030–4.472, p=0.041), vasculitis (2.650, 1.037–6.773,p =0.042), and remission duration (0.987, 0.980–0.995, p<0.001). By Cox regression analysis, predictors of shorter flare-free remission were thrombocytopenia (HR 2.446, CI 95% 1.106–5.410, p=0.027), vasculitis (3.033, 1.262–7.432, p=0.013), disease duration (0.943, 0.892–0.998, p=0.054), and positive anti-U1RNP (1.973, 0.988–3.940, p=0.054).Conclusion According to our results, remission off-GCs is an achievable outcome in SLE, especially in patients without serological activity and in those with stable remission.