AB0449 IMPACT OF REMISSION AND LOW DISEASE ACTIVITY (LDA) ON HEALTH-RELATED QUALITY OF LIFE (HRQOL) IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) PATIENTS: A SYSTEMATIC LITERATURE REVIEW (SLR)
Authors: M. F. Ugarte-Gil, C. Mendoza Pinto, C. Reategui Sokolova, G. Pons-Estel, R. Van Vollenhoven, G. Bertsias, G. S. Alarcon, B. Pons-Estel
Journal: Annals of the Rheumatic Diseases (2020)

Background: Treat-to-target strategy has been proposed in SLE. Achieving remission/LDAS should prevent damage, reduce mortality and improve HRQoL. Objectives: To determine the protective value of remission or LDA states on HRQoL in SLE using a SLR. Methods: Two independent reviewers identified studies in Medline and Cochrane library and extracted data on remission, LDA and HRQoL. Remission and LDA definitions included disease activity (SLEDAI and its variants, SLAM and PGA), serological activity, new organ/system, prednisone (PDN) dose (mg/day), immunosuppressives (IS) drugs, antimalarial (AM) use and remission duration. The quality of the studies was assessed with the Newcastle-Otawa Scale (NOS). Results: Three manuscripts (1059 patients) for remission and 4 (2385 patients) for LDA were included (America, Europe &amp; Asia Pacific). All the studies reached seven out of nine NOS points. Remission rates ranged 25-39%; and LDA: 42-62%. Even less stringent remission or LDA definitions predicted/were associated with a better HRQoL. Physical rather than mental domains were more associated with remission or LDA. Table 1. Association between remission and HRQoL Authors Country/Region Patients Remission Remission (%) Domains positively associated or predicted by remission Mok et al* China 769 SLEDAI=0 Serologic= Allowed PGA&lt;0.5 PDN ≤ 5 IS=Yes AM=Yes Duration≥5years 25.1 Remission&gt;5 years vs not on remission SF-36: Role physical, bodily pain, general health, vitality, social functioning, role emotional, PCS and MCS LupusPRO: Symptoms, medications, procreation, physical health, pain, emotional, image, HRQoL total Tsang-A-Sjoe et al# Netherlands 154 SLEDAI=0 Serologic= allowed PGA ≤2/10 PDN ≤ 5 IS=Yes AM=Yes Duration=NR 39.0 at baseline Remission on- or off-therapy predicted a better SF-36 PCS but not MCS Margiotta et al* Italy 136 SLEDAI=0 Serologic= allowed PGA= NR PDN ≤ 5 IS=Yes AM=Yes Duration&gt;5 years 39.0 Remission &gt;5years vs unremitted or remission&lt;5 years SF-36: Physical health, role physical, bodily pain, general health, social functioning PCS: Physical component summary. MCS: Mental component summary. *Cross-sectional #Longitudinal Table 2. Association between LDA and HRQoL Authors Country/Region Patients LDA LDA (%) Domains positively associated or predicted by LDAS Golder et al* Asia Pacific 1422 SLEDAI≤ 4 PGA≤ 1 PDN ≤ 7.5 IS=Yes AM=Yes New manifestations: No Duration=NR 42.0 SF-36: Role physical, bodily pain, general health, vitality, social functioning, role emotional, mental health, PCS and MCS Ugarte-Gil et al# USA 483 SLAM≤ 3 PGA=NR PDN ≤ 7.5 IS=No AM=Yes New manifestations: NR Duration=NR NR SF-36: Physical function, role physical, bodily pain, general health, vitality, social functioning, role emotional, mental health, PCS and MCS Ugarte-Gil et al# Peru 243 SLEDAI≤ 4 PGA=NR PDN ≤ 7.5 IS=Yes AM=Yes New manifestations: NR Duration=NR 48.6 at baseline LupusQoL Physical health, pain, planning, burden to others, emotional health, fatigue Poomsalood et al* Thailand 237 SLEDAI≤ 2 Serologic= allowed PGA=NR PDN ≤ 7.5 IS=Yes AM=Yes New manifestations: NR Duration=NR 61.6 SLEQoL Univariable: physical, activities, symptom, treatment, mood, self-image and total. Multivariable: Better global QoL PCS: Physical component summary. MCS: Mental component summary. *Cross-sectional #Longitudinal Conclusion: In SLE patients, achieving remission or LDA, is associated with a better HRQoL. Disclosure of Interests: Manuel F. Ugarte-Gil Grant/research support from: Jannsen, Pfizer, Claudia Mendoza Pinto: None declared, Cristina Reategui Sokolova: None declared, Guillermo Pons-Estel Grant/research support from: JANSSEN and GSK, Consultant of: JANNSEN, GSK and SANOFI, Speakers bureau: PFIZER, JANNSEN and GSK, 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