AB0448 IMPACT OF REMISSION ON DAMAGE ACCRUAL IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) PATIENTS: A SYSTEMATIC LITERATURE REVIEW (SLR)
Authors: M. F. Ugarte-Gil, C. Mendoza Pinto, G. Pons-Estel, C. Reategui Sokolova, R. Van Vollenhoven, G. Bertsias, G. S. Alarcon, B. Pons-Estel
Journal: Annals of the Rheumatic Diseases (2020)

Background: Treat-to-target strategy with remission as the target has been proposed for the management of SLE. However, there is not a uniform definition of remission. Objectives: To determine the protective value of remission state on organ damage accrual in SLE patients through a SLR. Methods: Two independent reviewers identified studies in Medline and Cochrane Library. Data on remission definitions and rates as well as damage accrual (assessed by the SLICC/ACR damage index [SDI]) were extracted. Definitions of remission included disease activity indices (SLEDAI and its variants and PGA), serological activity, prednisone (PDN) daily dose (mg/day), immunosuppressive (IS) drugs, antimalarial (AM) use and duration of remission. The quality of the studies was evaluated with the Newcastle-Otawa Scale (NOS). Results: Eight manuscripts were included comprising more than 6,000 patients from America, Europe and Asia Pacific. All the studies were longitudinal. The majority of the studies reached more than seven out nine points in the NOS. Remission rates ranged between 10 and almost 50%; they tend to be lower in America as compared to Asia Pacific and Europe. All definitions required a clinical SLEDAI=0, and allowed antimalarial use. However, there were differences regarding the inclusion of serological activity, PGA, prednisone or immunosuppressive drug use as well as minimum remission duration required. Even less stringent definition of remission prevented damage accrual. The risk of damage accrual was two to five-fold lower in those patients on remission. Authors Country/ Region Patients Remission Achieving remission (%) Damage: remission vs not remission NOS Zen et al Italy 224 SLEDAI=0 Serologic= allowed PGA= NR PDN ≤ 5 IS=Yes AM=Yes Duration=5 years 37.5% Unremitted disease OR=2.53; p=0.008 7 Tani et al Italy 115 SLEDAI=0 Serologic PGA= NR PDN ≤ 5 IS=Yes AM=Yes Duration=NR 49.6% ΔSLICC 0.12 vs 0.48,p= 0.018 8 Ugarte-Gil et al Latin America 1,350 SLEDAI=0 Serologic= not allowed PGA= NR PDN ≤ 5 IS=Yes AM=Yes Duration=NR 20.2% New damage HR 0.60 p=0.0042 Severe new damage HR 0.32 p=0.0033 8 Tsang-A-Sjoe et al Netherlands 224 SLEDAI=0 Serologic= allowed PGA= NR PDN ≤ 5 IS=Yes AM=Yes Duration&gt;5 years 37.6% OR=0.20; p=0.001 8 Mok et al China 769 SLEDAI=0 Serologic= Allowed PGA&lt;0.5 PDN ≤ 5 IS=Yes AM=Yes Duration≥5years 25.1% Not being on remission for at least 5 years OR: 2.42; p&lt;0.001 7 Tselios et al Canada 267 SLEDAI=0 Serologic= Allowed PGA=NR PDN no restriction IS no restriction AM=Yes Duration≥5years 10.1% SDI after 10 years: 0.96 vs 1.53 (not on remission, not on LDAS), p for trend =0.029 7 Petri et al US 1,356 SLEDAI=0 Serologic= NR PGA&lt;0.5 PDN ≤ 5 IS=Yes AM=Yes Duration= NR NR Rate ratio per percentage of follow-up RR(&lt;25%)=0.54; p&lt;0.0001 RR(25-49%)=0.47; p&lt;0.0001 RR(50-74%)=0.43; p&lt;0.0001 RR(&gt;75%)=0.45; p=0.0019 7 Golder et al Asia Pacific 1,707 SLEDAI=0 Serologic=Yes PGA&lt;0.5 PDN ≤ 5 IS=Yes AM=Yes Duration= NR 35.8% HR=0.55; p&lt;0.0001 6 NR: Not recorded. OR: Odds Ratio. HR: Hazard ratio. RR: Rate ratio Conclusion: In SLE patients, achieving remission, even with less stringent definitions, prevented damage accrual. Disclosure of Interests: : Manuel F. Ugarte-Gil Grant/research support from: Jannsen, Pfizer, Claudia Mendoza Pinto: None declared, Guillermo Pons-Estel Grant/research support from: JANSSEN and GSK, Consultant of: JANNSEN, GSK and SANOFI, Speakers bureau: PFIZER, JANNSEN and GSK, Cristina Reategui Sokolova: None declared, Ronald van Vollenhoven Grant/research support from: AbbVie, Arthrogen, Bristol-Myers Squibb, GlaxoSmithKline, Lilly, Pfizer, and UCB, Consultant of: AbbVie, AstraZeneca, Biotest, Bristol-Myers Squibb, Celgene, GSK, Janssen, Lilly, Medac, Merck, Novartis, Pfizer, Roche, and UCB, George Bertsias Grant/research support from: GSK, Consultant of: Novartis, Graciela S Alarcon: None declared, Bernardo Pons-Estel Grant/research support from: GSK, Janssen, Consultant of: GSK, Janssen, Speakers bureau: GSK, Janssen