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Abstract
Background Remission is the ultimate goal in SLE. However, after more than 50 years of research on this topic, no agreement on the definition of remission has been widely accepted. Developing definition(s) of remission was one of the primary research recommendations of the treat-to-target (T2T/SLE) international task force. Definitions of remission were agreed on by an international collaboration from the DORIS working group [1].
Objectives In this study, we applied four DORIS definitions of remission to a large cohort to determine the time to remission, duration of remission and predictors of remission.
Methods The four DORIS definitions of remission are Clinical Remission, Complete Remission, Clinical ROT (remission on treatment) and Complete ROT. Any definition requires the clinical Systemic Lupus Disease Activity Index (cSLEDAI), meaning without serology, to be 0 and the Physician Global Assessment (PGA) to be <0.5 (0–3 VAS). For Remission, prednisone intake has to be 0 and immunosuppressives are not allowed. For ROT, prednisone intake has to be ≤5 mg per day and immunosuppressives are allowed. Clinical Remission and Clinical ROT are regardless of serology, whereas Complete Remission and Complete ROT require negative anti-ds DNA and normal complement. 2263 patients were included in our analyses. Patients entered the cohort from 1987 to 2014 and were seen at least quarterly. Patients not in remission at cohort entry were followed prospectively. We used the Kaplan-Meier approach to estimate the distribution of time to remission after cohort entry. Once remission was achieved, patients were followed prospectively until relapse occurred. The Kaplan-Meier approach was used to estimate the distribution of time from remission to relapse. Cox regression was used to identify baseline factors associated with time to remission, adjusting for baseline level of disease activity and baseline treatment.
Results The median time to remission is 8.7, 11, 1.8 and 3.1 years for Clinical Remission, Complete Remission, Clinical ROT and Complete ROT, respectively. High baseline treatment is the major predictor of a longer time to remission, followed by high baseline activity (Figure). The median duration of remission is just three months. Surprisingly, this is quite similar for all the definitions. African-American ethnicity, baseline low C3 and baseline hematologic activity are negative predictors for time to remission for all definitions. Baseline anti-dsDNA and baseline low C4 are negative predictors for Complete Remission and for Complete ROT. Baseline low C4 is also a negative predictor for Clinical Remission. In multivariable models, income and education were not significant after controlling for race. Furthermore, we did not find a significant association for sex, age group and the use of hydroxychloroquine.
Conclusions Our results provide further insights into the frequency and duration of remission in SLE and call attention to the major role of baseline activity and baseline treatment in predicting remission.
van Vollenhoven RF, Aranow C, Bertsias G, et al., Remission in SLE: consensus findings from a large international panel on definitions of remission in SLE (DORIS). Ann Rheum Dis 2015;73:671
Disclosure of Interest None declared