Transitioning from Lupus Low Disease Activity State to remission in systemic lupus erythematosus: real-world evidence.

IF 5.7 2区医学 Q1 IMMUNOLOGY

Frontiers in Immunology Pub Date : 2025-03-20 eCollection Date: 2025-01-01 DOI:10.3389/fimmu.2025.1546306

Dai Gao, Lanlan Ji, Xiaohui Zhang, Yanjie Hao, Wenhui Xie, Yong Fan, Zhuoli Zhang

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引用次数: 0

Abstract

Objectives: To identify predictors and barriers to achieving remission in systemic lupus erythematosus (SLE) patients after attaining Lupus Low Disease Activity State (LLDAS).

Methods: This study included patients from the Sle to TARget (STAR) cohort who did not fulfill LLDAS at baseline. The Kaplan-Meier method was used to estimate the cumulative probabilities of remission or flare after LLDAS attainment. Univariate and multivariable Cox proportional hazards models were employed to identify predictors of time to remission. Barriers impeding remission achievement were also investigated.

Results: Of 586 enrolled patients, 480 achieved LLDAS within 20.4 months (IQR 13.4-37.1). Among these, 369 patients who did not achieve remission simultaneously with LLDAS attainment and had ongoing follow-up were included in further analysis. Subsequently, 297 (80.5%) patients achieved remission, with median times to remission and flare of 12.4 and 24.4 months, respectively. Independent predictors of a shorter time to remission included older age at disease onset (HR 1.012, 95%CI=1.004-1.020, P=0.002), arthritis (HR 1.481, 95%CI=1.113-1.969, P=0.007), and gastrointestinal involvement (HR 1.994, 95%CI=1.230-3.232, P=0.005). Conversely, anemia (HR 0.564, 95%CI=0.428-0.743, P<0.001) was a risk predictor. Higher disease activity defined by SLE Disease Activity Index 2000 (HR 0.691, 95%CI=0.632-0.757, P<0.001) or the Physician's Global Assessment (HR 0.062, 95%CI=0.031-0.127, P<0.001) and the presence of rash (HR 0.156, 95%CI=0.049-0.499, P=0.002), anti-dsDNA positivity (HR 0.513, 95%CI=0.403-0.654, P<0.001), hypocomplementemia (HR 0.468, 95%CI=0.346-0.632, P<0.001), or thrombocytopenia (HR 0.138, 95%CI=0.051-0.377, P<0.001) at the time of LLDAS attainment also demonstrated negative associations with remission. Patients maintaining hydroxychloroquine (HR 1.662, 95%CI=1.115-2.477, P=0.013) or cyclophosphamide (HR 3.468, 95%CI=1.959-6.141, P<0.001) regimens at LLDAS exhibited a shorter time to remission. Moreover, 68.7% of patients failed to achieve remission at the visit preceding remission solely due to prednisone doses of ≥5 mg/day, while other criteria impeded only 5.7-8.4% of cases.

Conclusions: Achieving rapid remission after LLDAS attainment remains challenging for most SLE patients, mainly due to difficulties in reducing prednisone dosage to ≤5 mg/day.

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从狼疮低疾病活动状态到系统性红斑狼疮缓解的过渡：真实世界的证据。

目的：确定系统性红斑狼疮（SLE）患者在达到狼疮低疾病活动状态（LLDAS）后实现缓解的预测因素和障碍。方法：本研究纳入了Sle到TARget （STAR）队列中基线时未达到LLDAS的患者。Kaplan-Meier方法用于估计LLDAS达到后缓解或发作的累积概率。采用单变量和多变量Cox比例风险模型来确定缓解时间的预测因子。阻碍缓解实现的障碍也进行了调查。结果：586例入组患者中，480例在20.4个月内达到LLDAS （IQR 13.4-37.1）。其中，369名未同时达到LLDAS缓解且持续随访的患者被纳入进一步分析。随后，297例（80.5%）患者获得缓解，中位缓解时间和发作时间分别为12.4个月和24.4个月。较短缓解时间的独立预测因子包括发病年龄较大（HR 1.012, 95%CI=1.004-1.020， P=0.002）、关节炎（HR 1.481, 95%CI=1.113-1.969， P=0.007）和胃肠道受累（HR 1.994, 95%CI=1.230-3.232， P=0.005）。相反，贫血（HR 0.564, 95%CI=0.428-0.743， PPPP=0.002）、抗dsdna阳性（HR 0.513, 95%CI=0.403-0.654， PPPP=0.013）或环磷酰胺（HR 3.468, 95%CI=1.959-6.141）对大多数SLE患者来说，在LLDAS达到后实现快速缓解仍然具有挑战性，主要原因是强的松剂量难以减少到≤5 mg/天。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Immunology IMMUNOLOGY-

CiteScore

9.80

自引率

11.00%

发文量

7153

审稿时长

14 weeks

期刊介绍： Frontiers in Immunology is a leading journal in its field, publishing rigorously peer-reviewed research across basic, translational and clinical immunology. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide. Frontiers in Immunology is the official Journal of the International Union of Immunological Societies (IUIS). Encompassing the entire field of Immunology, this journal welcomes papers that investigate basic mechanisms of immune system development and function, with a particular emphasis given to the description of the clinical and immunological phenotype of human immune disorders, and on the definition of their molecular basis.