Analysis of Complete Remission in Systemic Lupus Erythematosus Patients Over a 32‐Year Period

Abstract

Objective. Systemic lupus erythematosus (SLE) is characterized by an unpredictable and fluctuating course. Although various methods have been developed to measure disease activity, there is still a lack of consensus about the optimal criteria for SLE remission. The principal aim of our study was to identify the number of lupus patients achieving a complete remission (implying that for 3 years there were no clinical or serologic features and no treatment with steroids and immunosuppressive drugs) in a single cohort of patients followed for a period of up to 32 years. In addition, we have identified patients in clinical but not serologic remission (known as serologically active, clinically quiescent disease [SACQ]) and vice versa. We were particularly interested to determine the factors associated with complete remission. Methods. Eligible patients were followed up in the University College Hospital Lupus cohort from January 1978 until December 2010 for a period of at least 3 years. Complete remission was defined as a period of at least 3 years with clinical inactivity (British Isles Lupus Assessment Group scores of C, D, or E only) and laboratory remission (no antibodies to double-stranded DNA and normal complement C3 levels), and being off-treatment with corticosteroids and immunosuppressants. Antimalarial and nonsteroidal antiinflammatory drugs were allowed. Results. Of 624 lupus patients at our hospital, a total of 532 patients met the strict inclusion criteria for the study. Of these 532 patients, 77 patients (14.5%) achieved complete remission for at least 3 years, and 23 (4.3%) achieved complete remission for a minimum period of 10 years. Ten of these 77 patients were subsequently lost to followup, and, interestingly, flares occurred subsequently in 15 of the 67 remaining patients (22.4%). Three patients relapsed after the tenth year of remission. Forty-five patients (8.5%) fulfilled the requirement for SACQ, and 66 patients (12.4%) achieved only serologic remission. Conclusion. Our study indicated that 14.5% of lupus patients achieved a complete remission for 3 years. However, flares may continue to occur beyond 10 years of remission. Long-term followup of SLE is therefore mandatory.

Effect of Sustained Clinical Remission on the Risk of Lupus Flares and Impaired Kidney Function in Patients With Lupus Nephritis

“…Older age, treatment with hydroxychloroquine, and absence of arterial hypertension increased the probability of sCR. In keeping with our results, previous studies 22 , 39 outlined that older age and use of hydroxychloroquine were independent predictors of remission in SLE. It is well known that LN has a more severe course in young patients, and our data show that for them it is more difficult to achieve sCR, suggesting the need for a closer monitoring of young patients from the beginning of the disease.…”

Long‐term remission in patients with systemic lupus erythematosus

“…Cervera et al in a multicenter study reported more severe disease and relapse in Caribbean and Hispanic patients 27 . In Medina‐Quiñones et al report, remission rate in white patients was more than non‐whites 26 . However, all patients included in our study were Iranian Azeris or Kurds.…”

“…However, sustained remission in their report was rare and attained in 8.3% of patients 7 . Medina‐Quiñones et al defined complete remission as clinical and serologic remission for 3 years and stopping treatment with GCs and IS 26 . They reported that 14.5% of their patients obtained complete remission and 5.5% of their patients discontinued all medications including antimalarials 26 .…”

How do systemic lupus erythematosus patients with very-long disease duration present? Analysis of a monocentric cohort

“…Premising that different remission definitions are used in the past years preventing a valid way of comparison, these results are in line with previous reports showing that disease activity decreased over time and sustained remission may be an achievable goal in the majority of patients. [22][23][24][25] Then, we described the disease path during the longterm follow-up and we found that the majority of our patients (66.7%) experienced at least one flare during the course of the disease and in more than half of the cases, major organs were involved. Most of the patients (67.9%) experienced at least one disease flare within 10 years from diagnosis.…”