Ab0448 impact of Remission on Damage Accrual in Systemic Lupus Erythematosus (Sle) Patients: A Systematic Literature Review (Slr)

Abstract

Background:Treat-to-target strategy with remission as the target has been proposed for the management of SLE. However, there is not a uniform definition of remission.Objectives:To determine the protective value of remission state on organ damage accrual in SLE patients through a SLR.Methods:Two independent reviewers identified studies in Medline and Cochrane Library. Data on remission definitions and rates as well as damage accrual (assessed by the SLICC/ACR damage index [SDI]) were extracted. Definitions of remission included disease activity indices (SLEDAI and its variants and PGA), serological activity, prednisone (PDN) daily dose (mg/day), immunosuppressive (IS) drugs, antimalarial (AM) use and duration of remission. The quality of the studies was evaluated with the Newcastle-Otawa Scale (NOS).Results:Eight manuscripts were included comprising more than 6,000 patients from America, Europe and Asia Pacific. All the studies were longitudinal. The majority of the studies reached more than seven out nine points in the NOS. Remission rates ranged between 10 and almost 50%; they tend to be lower in America as compared to Asia Pacific and Europe. All definitions required a clinical SLEDAI=0, and allowed antimalarial use. However, there were differences regarding the inclusion of serological activity, PGA, prednisone or immunosuppressive drug use as well as minimum remission duration required. Even less stringent definition of remission prevented damage accrual. The risk of damage accrual was two to five-fold lower in those patients on remission.AuthorsCountry/ RegionPatientsRemissionAchieving remission (%)Damage: remission vs not remissionNOSZen et alItaly224SLEDAI=0Serologic= allowedPGA= NRPDN ≤ 5IS=YesAM=YesDuration=5 years37.5%Unremitted diseaseOR=2.53; p=0.0087Tani et alItaly115SLEDAI=0SerologicPGA= NRPDN ≤ 5IS=YesAM=YesDuration=NR49.6%ΔSLICC 0.12 vs 0.48,p= 0.0188Ugarte-Gil et alLatin America1,350SLEDAI=0Serologic= not allowedPGA= NRPDN ≤ 5IS=YesAM=YesDuration=NR20.2%New damageHR 0.60 p=0.0042Severe new damageHR 0.32 p=0.00338Tsang-A-Sjoe et alNetherlands224SLEDAI=0Serologic= allowedPGA= NRPDN ≤ 5IS=YesAM=YesDuration>5 years37.6%OR=0.20; p=0.0018Mok et alChina769SLEDAI=0Serologic= AllowedPGA<0.5PDN ≤ 5IS=YesAM=YesDuration≥5years25.1%Not being on remission for at least 5 yearsOR: 2.42; p<0.0017Tselios et alCanada267SLEDAI=0Serologic= AllowedPGA=NRPDN no restrictionIS no restrictionAM=YesDuration≥5years10.1%SDI after 10 years: 0.96 vs 1.53 (not on remission, not on LDAS), p for trend =0.0297Petri et alUS1,356SLEDAI=0Serologic= NRPGA<0.5PDN ≤ 5IS=YesAM=YesDuration= NRNRRate ratio per percentage of follow-upRR(<25%)=0.54; p<0.0001RR(25-49%)=0.47; p<0.0001RR(50-74%)=0.43; p<0.0001RR(>75%)=0.45; p=0.00197Golder et alAsia Pacific1,707SLEDAI=0Serologic=YesPGA<0.5PDN ≤ 5IS=YesAM=YesDuration= NR35.8%HR=0.55; p<0.00016NR: Not recorded. OR: Odds Ratio. HR: Hazard ratio. RR: Rate ratioConclusion:In SLE patients, achieving remission, even with less stringent definitions, prevented damage accrual.Disclosure of Interests: :Manuel F. Ugarte-Gil Grant/research support from: Jannsen, Pfizer, Claudia Mendoza Pinto: None declared, Guillermo Pons-Estel Grant/research support from: JANSSEN and GSK, Consultant of: JANNSEN, GSK and SANOFI, Speakers bureau: PFIZER, JANNSEN and GSK, Cristina Reategui Sokolova: None declared, Ronald van Vollenhoven Grant/research support from: AbbVie, Arthrogen, Bristol-Myers Squibb, GlaxoSmithKline, Lilly, Pfizer, and UCB, Consultant of: AbbVie, AstraZeneca, Biotest, Bristol-Myers Squibb, Celgene, GSK, Janssen, Lilly, Medac, Merck, Novartis, Pfizer, Roche, and UCB, George Bertsias Grant/research support from: GSK, Consultant of: Novartis, Graciela S Alarcon: None declared, Bernardo Pons-Estel Grant/research support from: GSK, Janssen, Consultant of: GSK, Janssen, Speakers bureau: GSK, Janssen

2021 DORIS definition of remission in SLE: final recommendations from an international task force

“…The full results of the SLR on the influence of remission on health-related quality of life (HR-QoL) and on damage have been presented 5 and will be published elsewhere. Three studies investigated the association between being or staying in remission (by any definition) and HR-QoL and concluded that remission by any definition was associated with better HR-QoL.…”

Remission and low disease activity (LDA) prevent damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort

“…According to these data, remission could be an achievable state in many patients, and it should remain as the ideal target in SLE treatment. However, as more stringent definitions (remission off-and on-treatment) are less frequently achieved in patients with a higher risk of poorer outcomes (like non-White populations or with more severe manifestations), less stringent definitions could be more realistic outcomes for the treatment of SLE patients (2,(41)(42)(43). For example, EULAR and PANLAR guidelines recommended remission or LDA as the therapeutic goal (44,45).…”

“…Remission and low disease activity (LDA) have been proposed as targets for the management of systemic lupus erythematosus (SLE) (1). These states have been associated with a lower probability of mortality, damage, flares, hospitalization, costs, cardiovascular events and with a better health-related quality of life (HRQoL) (2). However, there are various definitions of these states.…”

Chinese SLE Treatment and Research Group Registry (CSTAR) XIV: the subjective well-being of patients with systemic lupus erythematosus

“…In the wake of the principle of treating-to-target (T2T) in rheumatoid arthritis, remission and LDAS have been proposed as desirable therapeutic goals for patients with SLE (2,21,41). Emerging studies have demonstrated that the attainment of remission/LDAS was associated with improved outcomes in SLE, including lower damage accrual, lower probability of flares, and a better HRQoL (42). Regarding HRQoL, being on remission/LDAS was reported to predict higher scores in the components of physical health, but not in the components of mental health (16,18,42).…”

“…Emerging studies have demonstrated that the attainment of remission/LDAS was associated with improved outcomes in SLE, including lower damage accrual, lower probability of flares, and a better HRQoL (42). Regarding HRQoL, being on remission/LDAS was reported to predict higher scores in the components of physical health, but not in the components of mental health (16,18,42). The data from our study also indicated a lack of associations between remission/LDAS and SWB, probably because the mental domains are influenced by more complicated factors such as demographic characteristics, personality, and culture except for SLE-related factors involved in the definition of remission/LDAS at present.…”