Background Developing definition(s) of remission in SLE is one of the primary recommendations on the research agenda of the treat-to-taget (T2T/SLE) international task force  as it is required to apply the important principle of T2T to SLE. Definitions of remission were agreed on by an international collaboration from the EULAR working group.
Objectives We applied the definitions from the EULAR working group to a large clinical cohort to determine the distribution of time to remission, durability and predictors of remission.
Methods Remission was defined as clinical Systemic Lupus Disease Activity Index (SLEDAI) =0, with Physician Global Assessment (PGA) ≤0.5, prednisone ≤5 mg per day and no immunosuppression. Remission on treatment (ROT) was defined as clinical SLEDAI =0, with PGA ≤0.5, prednisone ≤5 mg per day and allowance of immunosuppressives. Hydroxychloroquine was allowed for remission and ROT. The Kaplan-Meier approach was used to estimate the distribution of time until remission among patients who entered the cohort with disease activity. In addition, for patients on treatment, we identified variables that were predictive of remission in the next two visits.
Results The median time to remission was 2.8 years in women and 5.7 years in men, whereas the median time to ROT was 1.3 years in women and 2.1 years in men. Of those who satisfied the definition of remission, 59% had a relapse manifested at a clinic visit within the next 90 days, and 15% more had a relapse from 90 to 180 days post remission. Only 11% had a remission lasting over one year. Considering patients treated with immunosuppressives or prednisone greater than 5 mg/day at one visit, 2.8% successfully tapered treatment and achieved remission over the next two visits. The table below shows rates of remission in various subgroups.
Conclusions 50% of women and men with SLE achieve remission within 2.8 years and 5.7 years, respectively. However, most of them experience a relapse within the next 90 days. This reflects the relapsing-remitting nature of SLE for many patients. Remission and remisson on treatment are frequent in SLE. Durable remission, though, is rare. Only 11% will have durability of more than one year. African-American ethnicity, anti-dsDNA or low complement predict against achieving remission. Our results provide further insights into the nature of remission in SLE and contribute towards applying the treat-to-target principle to SLE.
van Vollenhoven, R.F., et al., Treat-to-target in systemic lupus erythematosus: recommendations from an international task force. Ann Rheum Dis, 2014. 73(6): p. 958-67.
Disclosure of Interest None declared