FRI0347 Performance of potential definitions of remission in systemic lupus erythematosus (SLE) versus quality of life over 5 years in swedish patients with recent-onset sle
Authors: M. Björk, R. Heijke, M. Frodlund, S. Ramagopalan, E. Alemao, C. Sjöwall
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Remission constitutes a desirable goal in the management and treatment of patients with systemic lupus erythematosus (SLE), but no universally accepted definition exists. Based on established disease activity measures (e.g. clinical SLE Disease Activity Index [cSLEDAI], physician's global assessment [PhGA] and British Isles Lupus Assessment Group [BILAG] index), serology (anti-double-stranded DNA antibodies and low complement) and ongoing therapy, an international task force recently suggested four preliminary definitions of remission in SLE (DORIS).<sup>1</sup> However, the definitions did not include any patient-reported outcome measures (PROMs). <h3>Objectives</h3> Using data from well-characterised Swedish patients with recent-onset SLE included in the KLURING (<i>Clinical Lupus Register In Northeastern Gothia</i>) cohort, we aimed to describe the performance of the four definitions over 5 years in relation to PROMs and quality of life (QoL) as defined by EuroQoL-5 Dimensions (EQ-5D). <h3>Methods</h3> Patients with SLE who met the 1982 ACR and/or the 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria were included and followed prospectively from the time point of SLE diagnosis. Patients were (at least) seen by a rheumatologist at Months 0 (inclusion), 6, 12, 24, 36, 48 and 60, with collection of disease activity measures, damage accrual, serology, therapy and PROMs such as fatigue, pain intensity, well-being (all visual analogue scale) and QoL (EQ-5D). Definitions of remission were: <b>DORIS 1A</b>: cSLEDAI 0, PhGA &lt;0.5; <b>DORIS 1B</b>: cSLEDAI 0, PhGA &lt;0.5, serology normal; <b>DORIS 2A</b>: PhGA &lt;0.5, BILAG D/E only; <b>DORIS 2B</b>: PhGA &lt;0.5, serology normal, BILAG D/E only. Each definition could be reached either on or off treatment (maintenance with antimalarials only was allowed).<sup>1</sup> The effect on QoL of achieving versus not achieving remission was assessed using multilevel regression modelling. <h3>Results</h3> A total of 41 patients were included in the study: median (interquartile range) age at baseline 39 years, (18–77) 33/41 (81%) female, 35/41 (85%) white and 18/41 (44%) former/current tobacco smokers. The median number of fulfilled 1982 ACR criteria was 4 (range 3–9) and 15/41 (37%) had lupus nephritis. Using DORIS 1A or 2A, patients with SLE achieving versus not achieving remission had higher QoL (p=0.01), whether on or off treatment (figure 1). This association remained significant after adjusting for sex, tobacco smoking and treatment in multivariable analysis. Achieving remission according to DORIS 1B (p=0.93) or 2B (p=0.86) was not significantly decisive for QoL (figure 1). Bars represent% pts attaining remission (on vs off treatment) and lines represent mean EQ-5D (QoL) for pts (meeting vs not the definition of remission) at each time point since SLE onset <h3>Conclusions</h3> This pilot study demonstrates the first real-life performance of the suggested preliminary definitions of remission in SLE. Higher QoL was associated with achieving remission as defined by DORIS 1A or 2A. However, further evaluation of the accuracy of DORIS in larger longitudinal studies of recent-onset SLE is required before introduction in routine clinical practice. <h3>Reference</h3> [1] van Vollenhoven R, et al. Ann Rheum Dis2017;76:554–61. <h3>Disclosure of Interest</h3> M. Björk: None declared, R. Heijke: None declared, M. Frodlund: None declared, S. Ramagopalan Employee of: Bristol-Myers Squibb, E. Alemao Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, C. Sjöwall: None declared