Changes in disease activity status over time in patients with systemic lupus erythematosus: preliminary results from the prospective RELESSAR registry

Autores: Paula Fernández, Lucila García, Rosana Quintana, Karen Roberts, Carla Gobbi, Joan M. Dapeña, Marina Micelli, Paula Alba, Alejandro Brigante, Agustina Damico, Romina Rojas Tessel, Malena Viola, Gelsomina Alle, Lucía Mendoza Martínez, Florencia Gordillo, Claudia Pena, Verónica Bellomio, Paula Corbalan, Maitén Sarde, Gisela Pendon, Carolina Aeschlimann, Manuel Rodríguez, Bettina Sardi, Micaela Cosatti, Cecilia Pisoni, Mercedes García

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Introduction: systemic lupus erythematosus (SLE) has a heterogeneous course. States of remission or low disease activity (LDA) are associated with less accumulated damage and greater survival, supporting the treat-to-target strategy.

Objectives: to evaluate the distribution of remission, LDA, and active disease at baseline and at one year (T1) in the RELESSAR-prospective cohort, and to analyze the influence of baseline characteristics on disease activity status at one year.

Materials and methods: patients with ≤5 years of SLE duration were included. Definitions: Remission when SLEDAI-2K = 0, prednisone (PDN) ≤5 mg/day, and immunosuppression (IS) at maintenance doses; LDA when SLEDAI-2K ≤4, PDN ≤5 mg/day, and IS at maintenance doses; and active disease when SLEDAI-2K >4 and/or PDN >5 mg/day and/or induction therapy. Antimalarials were allowed. Assessments were performed at T0 (baseline visit) and T1 (one-year follow-up).

Results: of 246 patients, 109 were included. At one year, 26% achieved or maintained remission and 24% LDA, while 50% remained in or progressed to active disease. In the multivariable analysis, the patient global assessment (OR 1.36; 95% CI 1.13–1.67; p=0.002) and low complement C3 levels (OR 2.94; 95% CI 1.14–8.04; p=0.029) were independently associated with active disease at one year.

Conclusions: half of the patients had active disease at one year, which was associated with subjective (patient global assessment) and objective (low C3 levels) measures recorded at baseline. These findings reinforce the need for early and aggressive therapy to achieve treatment goals.