AB0280 THE INFLUENCE OF TARGET THERAPY AS WELL AS GLUCOCORTICOIDS TAPERING ON DISEASE FLARE IN SYSTEMIC LUPUS ERYTHEMATOSUS: RESULTS FROM A PROSPECTIVE CHINESE COHORT
Authors: Y. Hao, L. Ji, D. Gao, Y. Fan, B. Wei, Y. Geng, X. Zhang, G. Li, Z. Zhang
Journal: Annals of the Rheumatic Diseases (2021)

Background: Treat-to-target in systemic lupus erythematosus (SLE) has been proposed for 7 years and several recommendations were developed [1]. In these recommendations, prevention of flares should be a realistic target. Meanwhile, ‘remission’ or ‘low disease activity’ was recommended as the treatment target and minimizing glucocorticoids (GC) dose or withdrawal if possible was suggested in the maintenance treatment. However, would target therapy and GC tapering/withdrawal influence disease flare? Objectives: To investigate the frequency and determinants of disease flare, especially the influence of target therapy as well as GC tapering on flare in Chinese lupus patients. Methods: The baseline and follow-up data of all consecutive patients in a prospective longitudinal lupus cohort from January 2017 to June 2020 were collected. The lupus low disease activity state (LLDAS) was defined as in Golder et al., 2019[2]. The criteria for remission were from DORIS definitions [3]. Flare was assessed using the SELENA-SLEDAI flare index [4]. Results: We enrolled 185 patients with disease duration at recruitment of 2.3 (0.8–7.7) years. During the 26.2 (12.5-34.5) months of follow-up, 73 (39.5%) patients experienced 95 flares, including 70 mild/moderate and 25 severe flares. The incidence of flare per patient-year was 0.27. Kaplan-Meier analyses showed that compared with those who never achieved LLDAS or DORIS, the patients who achieved the target at least once had a higher flare free survival rate; meanwhile, the patients with prednisone withdrawn had significantly lower flare free rate compared with those with small dose of GC maintained (≤7.5mg/d) (Figure 1A), but among the patients with different prednisone maintain doses (7.5~5mg, 5~2.5mg, and ≤2.5mg) there was not significant difference (Figure 1B). Cox regression analysis showed that younger age at disease onset and lower Complement 3 (C3) level at recruitment were independent risk factors for flare and achieving LLDAS or DORIS ≥50% of visits was independent protective factor (Table 1). Conclusion: In this Chinese prospective SLE cohort, age at disease onset, C3 level at recruitment and therapeutic target achieving influenced disease flare independently and significantly. GC tapering in appropriate patients and with appropriate pace did not increase the flare rate, but prednisone withdrawal may induce more disease exacerbation, which needs to be confirmed by large prospective studies. References: [1]Van Vollenhoven R F, et al. Treat-to-target in systemic lupus erythematosus: recommendations from an international task force. Ann Rheum Dis, 2014. 73(6): 958-967 [2]Golder, V., et al. Lupus low disease activity state as a treatment endpoint for systemic lupus erythematosus: a prospective validation study. The Lancet Rheumatology, 2019. 1(2): p. e95-e102. [3]van Vollenhoven R, et al. A framework for remission in SLE: consensus findings from a large international task force on definitions of remission in SLE (DORIS). Ann Rheum Dis. 2017. 76(3): 554–561. [4]Petri M, et al. Classification and definition of major flares in SLE clinical trials. Lupus. 1999. 8(8): 685-691. Table 1. Determinants of disease flare by multivariate Cox regression analyses Model 1 (LLDAS) Δ Model 2(RONT) Δ Model 3 (Complete RONT) Δ HR 95%CI P value HR 95%CI P value HR 95%CI P value Age at disease onset (years ) † 0.97 0.95-0.99 0.004 0.97 0.95-0.99 0.003 0.97 0.95-0.99 0.003 Anti-dsDNA positive at recruitment 1.34 0.82-2.18 0.217 1.12 0.68-1.85 0.649 1.19 0.73-1.96 0.486 C3 (mg/L) at recruitment 0.998 0.997-0.999 0.004 0.998 0.997-0.999 0.007 0.998 0.997-1.000 0.010 Minimum prednisone dose during follow- up (mg/d ) 0.98 0.90-1.08 0.716 1.01 0.94-1.08 0.747 1.04 0.97-1.11 0.243 Therapeutic target achieved≥50% of observations Δ 0.60 0.39-0.94 0.001 0.54 0.34-0.87 0.011 0.68 0.51-0.92 0.011 Δ In the three hazard models, the different target achievement status were included respectively. RONT: Clinical remission on treatment; Complete RONT: Complete remission on treatment. Disclosure of Interests: None declared