Durao-Carvalho, Goncalo;
Fernandez-Gonzalez, Raquel;
Goulden, Bethan;
Farinha, Filipa;
Isenberg, David;
(2023)
Major determinants of prolonged remission in systemic lupus erythematosus: retrospective study over a 41+year period.
Rheumatology
, 62
(1)
pp. 209-216.
10.1093/rheumatology/keac242.
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Abstract
OBJECTIVES: To investigate predictors of sustained complete remission (CR) for 3 and 5 years, minimum. METHODS: Retrospective observational study from January 1978-december 2019, including Systemic Lupus Erythematosus (SLE) patients who attended the Lupus Clinic in a tertiary hospital, for at least 3 years. We used the British Isles Lupus Assessment Group (BILAG) score and serological profile to classify patients into CR, serologically active clinically quiescent (SACQ) and serological remission (SR). Multivariable cox regression analysis was performed to investigate predictors of CR and Kaplan-Meier curves were obtained. RESULTS: We included 564 patients; 15% achieved CR, 7% SACQ, 15% SR. 63% attained no remission. In the CR group, 73% sustained the remission for 5 or more years. Patients who did not reach any kind of sustained remission died significantly earlier (p< 0.001). Cumulative survival figures at 5, 10, 20 and 30 years were 100, 100, 94 and 90%, respectively, for CR patients and 96, 93, 77 and 58%, respectively, for patients in the no-remission group. Significant predictors of CR were white ethnicity, adjusted hazard ratio (HR) 2.16 [95% ci 1.30-3.59] p= 0.003; older age at diagnosis (>32-years), HR 1.92 [1.24-2.97] p= 0.003; absence of renal involvement, HR 2.55 [1.39-4.67] p= 0.002; and of antiphospholipid syndrome (APS), HR 4.92 [1.55-15.59] p= 0.007. CONCLUSION: Patients not achieving any kind of sustained remission have a higher risk of early mortality. White ethnicity, older age at diagnosis, absence of renal involvement and of APS were significantly associated with CR. Predictors for sustained CR do not change whether a 3-year or 5-year period is applied.
| Type: | Article |
|---|---|
| Title: | Major determinants of prolonged remission in systemic lupus erythematosus: retrospective study over a 41+year period |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1093/rheumatology/keac242 |
| Publisher version: | https://doi.org/10.1093/rheumatology/keac242 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions. |
| Keywords: | SLE, prolonged complete remission, off therapy, mortality |
| UCL classification: | UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10152536 |
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