Predictors of Remission and Low Disease Activity State in Systemic Lupus Erythematosus: Data from a multi-ethnic, multinational Latin-American Lupus Cohort

Objective To determine the predictors of remission and low disease activity state (LDAS) in systemic lupus erythematosus (SLE). Methods Three disease activity states were defined: Remission=SLEDAI=0 and prednisone≤5mg/d and/or immunosuppressants (maintenance dose); LDAS=SLEDAI≤4, prednisone≤7.5mg/d and/or immunosuppressants (maintenance dose); and non-optimally controlled state=SLEDAI>4 and/or prednisone>7.5mg/d and/or immunosuppressants (induction dose). Antimalarials were allowed in all groups. Patients with at least two SLEDAI reported and not optimally controlled at cohort entry were included in these analyses. Outcomes were remission and LDAS. Multivariable Cox regression models (stepwise selection procedure) were performed for remission and for LDAS. Results Of 1480 patients, 902 were non-optimally controlled at cohort entry; of them, 196 patients achieved remission (21.7%) and 314 achieved LDAS (34.8%). Variables predictive of a higher probability of remission were the absence of mucocutaneous manifestations [HR=1.571 (95%CI 1.064-2.320)], of renal involvement [HR=1.487 (95%CI 1.067-2.073)], and of hematologic involvement [HR=1.354 (95%CI 1.005-1.825)]; the use of immunosuppressive drugs before the baseline visit [HR=1.468 (95%CI 1.025-2.105)] and a lower SLEDAI at cohort entry [HR=1.028 (95%CI 1.006–1.051) per 1 unit decrease]. Older age at cohort entry, per five years increase [HR=1.050 (95%CI 1.004-1.098)]; absence of mucocutaneous manifestations [HR=1.401 (95%CI 1.016-1.930)], and renal involvement [HR=1.344 (95%CI 1.049-1.721)] as well as a lower SLEDAI at cohort entry [HR=1.025 (95%CI 1.009–1.042)] were predictive of LDAS. Conclusion The absence of mucocutaneous, renal and hematologic involvement, the use of immunosuppressive drugs and a lower disease activity early in the course of the disease were predictive of remission; older age was predictive of LDAS.