Predictors of Remission and Low Disease Activity State in Systemic Lupus Erythematosus: Data from a Multiethnic, Multinational Latin American Cohort

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art_UGARTE-GIL_Predictors_of_Remission_and_Low_Disease_Activity_State_2019.PDF (4.81 MB)
Citações na Scopus
22
Tipo de produção
article
Data de publicação
2019
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
J RHEUMATOL PUBL CO
Autores
UGARTE-GIL, Manuel F.
WOJDYLA, Daniel
PONS-ESTEL, Guillermo J.
QUINTANA, Rosana
GOMEZ-PUERTA, Jose A.
CATOGGIO, Luis J.
ALVARELLOS, Alejandro
SAURIT, Veronica
BORBA, Eduardo
Citação
JOURNAL OF RHEUMATOLOGY, v.46, n.10, p.1299-1308, 2019
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Objective. To determine the predictors of remission and low disease activity state (LDAS) in patients with systemic lupus erythematosus (SLE). Methods. Three disease activity states were defined: Remission = SLE Disease Activity Index (SLEDAI) = 0 and prednisone <= 5 mg/day and/or immunosuppressants (maintenance dose); LDAS = SLEDAI <= 4, prednisone <= 7.5 mg/day and/or immunosuppressants (maintenance dose); and non-optimally controlled state = SLEDAI > 4 and/or prednisone > 7.5 mg/day and/or immunosuppressants (induction dose). Antimalarials were allowed in all groups. Patients with at least 2 SLEDAI reported and not optimally controlled at entry were included in these analyses. Outcomes were remission and LDAS. Multivariable Cox regression models (stepwise selection procedure) were performed for remission and for LDAS. Results. Of 1480 patients, 902 were non-optimally controlled at entry; among them, 196 patients achieved remission (21.7%) and 314 achieved LDAS (34.8%). Variables predictive of a higher probability of remission were the absence of mucocutaneous manifestations (HR 1.571, 95% CI 1.064-2.320), absence of renal involvement (HR 1.487, 95% CI 1.067-2.073), and absence of hematologic involvement (HR 1.354, 95% CI 1.005-1.825); the use of immunosuppressive drugs before the baseline visit (HR 1.468, 95% CI 1.025-2.105); and a lower SLEDAI score at entry (HR 1.028, 95% CI 1.006-1.051 per 1-unit decrease). These variables were predictive of LDAS: older age at entry, per 5-year increase (HR 1.050, 95% CI 1.004-1.098); absence of mucocutaneous manifestations (HR 1.401, 95% CI 1.016-1.930) and renal involvement (HR 1.344, 95% CI 1.049-1.721); and lower SLEDAI score at entry (HR 1.025, 95% CI 1.009-1.042). Conclusion. Absence of mucocutaneous, renal, and hematologic involvement, use of immunosuppressive drugs, and lower disease activity early in the course of the disease were predictive of remission in patients with SLE; older age was predictive of LDAS.
Palavras-chave
SYSTEMIC LUPUS ERYTHEMATOSUS, REMISSION, LOW DISEASE ACTIVITY STATE, RISK FACTORS
URI
https://observatorio.fm.usp.br/handle/OPI/34124
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Coleções
Artigos e Materiais de Revistas Científicas - FM/Outros
Artigos e Materiais de Revistas Científicas - ODS/03