Remission in systemic lupus erythematosus: testing different definitions in a large multicentre cohort.

Abstract

OBJECTIVES:

Remission in systemic lupus erythematosus (SLE) is defined through a combination of 'clinical SLE Disease Activity Index (cSLEDAI)=0', 'physician's global assessment (PGA) <0.5' and 'prednisone (PDN) ≤5 mg/day'. We investigated the performance of these items, alone or in combination, in defining remission and in predicting SLICC/ACR Damage Index.

METHODS:

We tested seven potential definitions of remission in SLE patients followed-up for ≥5 years: PDN ≤5 mg/day; PGA <0.5; cSLEDAI=0; PGA <0.5 plus PDN ≤5 mg/day; cSLEDAI=0 plus PGA <0.5; cSLEDAI=0 plus PDN ≤5 mg/day; cSLEDAI=0 plus PDN ≤5 mg/day plus PGA <0.5. The effect of these definitions on damage was evaluated by Poisson regression analysis; the best performance was identified as the lowest Akaike and Bayesian information criterion (AIC and BIC). Positive and negative predictive values in identifying no damage increase were calculated.

RESULTS:

We included 646 patients (mean±SD disease duration 9.2±6.9 years). At multivariate analysis, ≥2 consecutive year remission according to all definitions protected against damage (OR, 95% CI: PGA <0.5 0.631, 0.444 to 0.896; cSLEDAI=0 0.531, 0.371 to 0.759; PGA <0.5 plus PDN ≤5 mg/day 0.554, 0.381 to 0.805; cSLEDAI=0 plus PGA <0.5 0.574, 0.400 to 0.826; cSLEDAI=0 plus PDN ≤5 mg/day 0.543, 0.376 to 0.785; cSLEDAI=0 plus PDN ≤5 mg/day plus PGA <0.5 0.532, 0.363 to 0.781, p<0.01 for all), except PDN ≤5 mg/day, which required four consecutive years (OR 0.534, 95% CI 0.325 to 0.877, p=0.013). Positive and negative predictive values were similar; however, cSLEDAI=0 showed the best performance (AIC 1082.90, BIC 1109.72, p<0.0001). Adding PGA <0.5 and/or PDN ≤5 mg/day to cSLEDAI=0 decreased remission duration (-1.8 and -1.5 year/patient, respectively) without increasing cSLEDAI=0 performance in predicting damage accrual.

CONCLUSIONS:

cSLEDAI=0 is the most attainable definition of remission, while displaying the best performance in predicting damage progression in the short-to-mid-term follow-up.

• Authors: Francesca Saccon, Margherita Zen, Mariele Gatto, Domenico Paolo Emanuele Margiotta, Antonella Afeltra, Fulvia Ceccarelli, Fabrizio Conti, Alessandra Bortoluzzi, Marcello Govoni, Giulia Frontini, Gabriella Moroni, Francesca Dall'Ara, Angela Tincani, Viola Signorini, Marta Mosca, Anna Chiara Frigo, Luca Iaccarino, Andrea Doria
• Journal: Annals of the rheumatic diseases (Ann Rheum Dis) Vol. 79 Issue 7 Pg. 943-950 (07 2020) ISSN: 1468-2060 [Electronic] England
• PMID: 32321721 (Publication Type: Comparative Study, Evaluation Study, Journal Article, Multicenter Study)
• Copyright: © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Anti-Inflammatory Agents
• Prednisone

Topics

• Adult
• Anti-Inflammatory Agents (administration & dosage)
• Bayes Theorem
• Cohort Studies
• Disease Progression
• Female
• Humans
• Italy
• Lupus Erythematosus, Systemic (classification, drug therapy)
• Male
• Middle Aged
• Multivariate Analysis
• Outcome Assessment, Health Care (methods)
• Prednisone (administration & dosage)
• Regression Analysis
• Remission Induction
• Severity of Illness Index