AB1289 TESTING DIFFERENT ITEMS INCLUDED IN THE DEFINITION OF REMISSION IN A MULTICENTRE SLE COHORT
Authors: Francesca Saccon, Margherita Zen, Mariele Gatto, Domenico Pe Margiotta, Fulvia Ceccarelli, Giulia Frontini, Gabriella Moroni, Alessandra Bortoluzzi, Marcello Govoni, Viola Signorini, Marta Mosca, Francesca Dall’ara, Angela Tincani, Anna Chiara Frigo, Antonella Afeltra, Fabrizio Conti, Andrea Doria
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Remission is the most desirable target in the treatment systemic lupus erythematosus (SLE) however, a universally accepted definition of remission in SLE is still missing. <h3>Objectives:</h3> To test the contribution of the different items included into the currently used definitions of remission in SLE. <h3>Methods:</h3> We studied 646 Caucasian patients from a multicentre lupus cohort followed for at least 5-years: female 585 (90.6%), mean age at baseline 40.59±12.14 years, mean disease duration 9.18±6.86 years. Disease activity was assessed by clinical SLE Disease Activity Index 2000 (cSLEDAI) and SELENA-SLEDAI physician global assessment (PGA), and damage by Systemic Lupus International Collaborating Clinics/ACR Damage Index (SDI). To test the performance of the different items included in the definitions of SLE remission [1, 2] we identify 7 subtypes of remission: (1) PGA (0-3)&lt;0.5; (2) cSLEDAI=0; (3) prednisone (PDN)≤5mg/day; (4) PGA&lt;0.5 and PDN≤5mg/day; (5) cSLEDAI=0 and PGA&lt;0.5; (6) cSLEDAI=0 and PDN≤5mg/day; (7) cSLEDAI=0 and PDN≤5mg/day and PGA&lt;0.5. The effect of remission on SDI was evaluated by Poisson regression analysis. <h3>Results:</h3> The number of patients achieving remission according to the different definitions is show in Figure 1. The proportion of patients who maintained prolonged remission (5-consecutive years) was: PGA&lt;0.5 13.0%; cSLEDAI=0 18.4%; PDN≤5mg/day 34.4%; PGA&lt;0.5 and PDN≤5mg/day 12.5%; cSLEDAI=0 and PGA&lt;0.5 12.7%; cSLEDAI=0 and PDN≤5mg/day 16.6%; cSLEDAI=0 and PDN≤5mg/day and PGA&lt;0.5 12.4%. When PGA&lt;0.5 was added to csledai, 198 (30.7%) patients lost 353 years in remission (1.8 years/patient): among them 195 (98.5%) showed a 0.5≤pga≤1 suggesting a low disease activity state (lda). when, pga&lt;0.5 was added to csledai =0 and pdn ≤5mg/day, 151 (23.5%) patients lost 254 years in remission (1.7 years/patient): among them 149 (98.0%) showed a 0.5≤pga≤1 suggesting again lda. all remission subtypes were protective against damage (p&lt;0.001), however csledai=0 showed the best performance (lower aic) (table 1). at multivariate analysis all remission subtypes lasting ≥2 consecutive years were protective against damage (p&lt;0.001), except pdn≤5mg/day which was protective after 4 consecutive years. <h3>Conclusion:</h3> The prevalence and extent of damage significantly decreased as the time spent in remission increased, irrespective of the remission subtype. The addition of PGA&lt;0.5 to cSLEDAI=0 or to cSLEDAI=0 and PDN≤5mg/day results in a decrease in the time spent in remission without significant difference in damage accrual. <h3>References</h3> [1] van Vollenhoven R, et al. 2014 [2] Zen M, et al. 2015 <h3>Disclosure of Interests:</h3> Francesca Saccon: None declared, Margherita Zen: None declared, Mariele Gatto: None declared, Domenico PE Margiotta: None declared, Fulvia Ceccarelli: None declared, Giulia Frontini: None declared, Gabriella Moroni: None declared, Alessandra Bortoluzzi: None declared, Marcello Govoni: None declared, Viola Signorini: None declared, Marta Mosca Paid instructor for: GlaxoSmithKline, Lilly, UCB, Francesca Dall'Ara: None declared, Angela Tincani Consultant for: UCB, Pfizer, Abbvie, BMS, Sanofi, Roche, GSK, AlphaSigma, Lillly, Jannsen, Cellgene, Novartis, Anna Chiara Frigo: None declared, Antonella Afeltra Grant/research support from: MSD, PFIZER, ABBVIE, ROCHE, UCB, Speakers bureau: MSD, PFIZER, BMS, ROCHE, SANOFI, fabrizio conti: None declared, Andrea Doria: None declared