AB0505 Early and sustained remission in sle can be achieved by using pulse methyl-prednisolone, hidroxychloroquine and low-medium dose-prednisone
Authors: B.R. Ruiz Estévez, G.R. Irastorza, E. Lázaro, I. Ruiz Arruza, P. Duffau, P. Blanco
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Objectives</h3> To compare the different therapeutic schemes used in two longitudinal cohorts of patients with Systemic Lupus Erythematosus (SLE): the Systemic Autoimmune Diseases Unit of Cruces University Hospital, Barakaldo, Spain (cohort C), using a low-medium dose prednisone scheme; and the Internal Medicine Department of Bordeaux, France (cohort B) which follows the standard treatment guidelines. <h3>Methods</h3> We included patients from both cohorts diagnosed with (SLE from year 2000), with a follow-up from the time of diagnosis (inception cohorts) and for at least 5 years. We analysed the different use of glucocorticoids (prednisone and pulse methylprednisolone), hydroxychloroquine (HCQ) and immunosuppressive drugs in both cohorts. To compare the efficacy of both therapeutic schemes, we analysed the rate of clinical remission and clinical remission on treatment, according to the DORIS definitions, during the 5 years of follow-up <h3>Results</h3> 173 patients were studied: Bordeaux (B): 81 and Cruces (C): 92. Baseline clinical variables were similar between both groups, including demographics, autoimmunity and organ involvement. The baseline SLEDAI was: 8 (B) vs. 7 (C), p=0.06. The proportion of patients in treatment with prednisone was similar from year 1: 79% (B) vs. 72% (C), p=0.269, to year 5: 63% (B) vs. 55% (C), p=0.315. However, patients in cohort B received higher doses of prednisone: mean maximum dose at year 1: 38 mg/d (B) vs. 14 mg/d (C), p&lt;0.05; at year 5: 8 mg/d (B) vs. 3 mg/d (C), p&lt;0.05; average dose of prednisone at year 1: 15.8 mg/d (B) vs. 4.4 mg/d (C), p&lt;0.05; at year 5: 6.6 mg/d (B) vs. 3.2 mg/d (C), p&lt;0.05. Methyl-prednisolone pulses were ever used in 26% (B) vs. 42% (C), p&lt;0.05; the mean total pulses per patient was 3 (B) vs. 7 (C), p&lt;0.05; however, the mean total dose of methyl-prednisolone per patient was similar 1725 mg (B) vs. 1635 mg (C), p=0.835, revealing a lower dose per pulse in patients from cohort C. The proportion of patients in treatment with HCQ was lower in cohort B at year 1: 80% (B) vs. 97% (C), p&lt;0.05 and at year 5: 73% (B) vs. 99% (C), p&lt;0.05. Methotrexate was used more frequently in cohort C (p&lt;0.05) with no differences in cyclophosphamide, azathioprine and mycophenolate use. Clinical remission in both cohorts was as follows: year 1: 25% (B) vs. 40% (C), p&lt;0.05; year 2: 29% (B) vs. 42% (C), p=0.07; year 3: 37% (B) vs. 42% (C), p=0.54; year 4: 37% (B) vs. 48% (C), p=0.15; year 5: 36% (B) vs. 49% (C), p=0.08. Clinical remission on treatment: year 1: 43% (B) vs. 84% (C), p&lt;0.05; year 2: 70% (B) vs. 87% (C), p&lt;0.05; year 3: 73% (B) vs. 88% (C), p&lt;0.05; year 4: 73% (B) vs. 93% (C), p&lt;0.05; year 5: 73% (B) vs. 93% (C), p&lt;0.05. <h3>Conclusions</h3> The more frequent use of hydroxychloroquine, pulse methylprednisolone and methotrexate in the Cruces cohort resulted in reduced doses of oral prednisone. Patients fron the Cruces cohort achieved clinical remission earlier and in a more sustained way during the follow–up. <h3>Disclosure of Interest</h3> None declared