PT  - JOURNAL ARTICLE
AU  - Francesca Saccon
AU  - Margherita Zen
AU  - Mariele Gatto
AU  - Domenico Paolo Emanuele Margiotta
AU  - Antonella Afeltra
AU  - Fulvia Ceccarelli
AU  - Fabrizio Conti
AU  - Alessandra Bortoluzzi
AU  - Marcello Govoni
AU  - Giulia Frontini
AU  - Gabriella Moroni
AU  - Francesca Dall'Ara
AU  - Angela Tincani
AU  - Viola Signorini
AU  - Marta Mosca
AU  - Anna Chiara Frigo
AU  - Luca Iaccarino
AU  - Andrea Doria
TI  - Remission in systemic lupus erythematosus: testing different definitions in a large multicentre cohort
AID  - 10.1136/annrheumdis-2020-217070
DP  - 2020 Jul 01
TA  - Annals of the Rheumatic Diseases
PG  - 943--950
VI  - 79
IP  - 7
4099  - http://ard.bmj.com/content/79/7/943.short
4100  - http://ard.bmj.com/content/79/7/943.full
SO  - Ann Rheum Dis2020 Jul 01; 79
AB  - Objectives Remission in systemic lupus erythematosus (SLE) is defined through a combination of ‘clinical SLE Disease Activity Index (cSLEDAI)=0’, ‘physician's global assessment (PGA) <0.5’ and ‘prednisone (PDN) ≤5 mg/day’. We investigated the performance of these items, alone or in combination, in defining remission and in predicting SLICC/ACR Damage Index.Methods We tested seven potential definitions of remission in SLE patients followed-up for ≥5 years: PDN ≤5 mg/day; PGA <0.5; cSLEDAI=0; PGA <0.5 plus PDN ≤5 mg/day; cSLEDAI=0 plus PGA <0.5; cSLEDAI=0 plus PDN ≤5 mg/day; cSLEDAI=0 plus PDN ≤5 mg/day plus PGA <0.5. The effect of these definitions on damage was evaluated by Poisson regression analysis; the best performance was identified as the lowest Akaike and Bayesian information criterion (AIC and BIC). Positive and negative predictive values in identifying no damage increase were calculated.Results We included 646 patients (mean±SD disease duration 9.2±6.9 years). At multivariate analysis, ≥2 consecutive year remission according to all definitions protected against damage (OR, 95% CI: PGA <0.5 0.631, 0.444 to 0.896; cSLEDAI=0 0.531, 0.371 to 0.759; PGA <0.5 plus PDN ≤5 mg/day 0.554, 0.381 to 0.805; cSLEDAI=0 plus PGA <0.5 0.574, 0.400 to 0.826; cSLEDAI=0 plus PDN ≤5 mg/day 0.543, 0.376 to 0.785; cSLEDAI=0 plus PDN ≤5 mg/day plus PGA <0.5 0.532, 0.363 to 0.781, p<0.01 for all), except PDN ≤5 mg/day, which required four consecutive years (OR 0.534, 95% CI 0.325 to 0.877, p=0.013). Positive and negative predictive values were similar; however, cSLEDAI=0 showed the best performance (AIC 1082.90, BIC 1109.72, p<0.0001). Adding PGA <0.5 and/or PDN ≤5 mg/day to cSLEDAI=0 decreased remission duration (−1.8 and −1.5 year/patient, respectively) without increasing cSLEDAI=0 performance in predicting damage accrual.Conclusions cSLEDAI=0 is the most attainable definition of remission, while displaying the best performance in predicting damage progression in the short-to-mid-term follow-up.