| Background: Remission has been introduced as a desirable outcome and the primary
target of treatment in systemic lupus erythematosus (SLE). The purpose of this study
was to identify the number of patients in remission and the long-term outcome of the
disease and their predictors.
Method: Of the 379 patients in our SLE Database, a total of 193 patients fulfilled
the inclusion criteria. Remission was definition according to the definitions of remission
in SLE. Three levels of remission were defined, including remission on-treatment,
remission off-treatment and complete remission. In addition, we have defined a sustained
remission for each level of remission in which the remission should last at least
5 years.
Results: During a median follow-up of 96 months, remission on-treatment and offtreatment,
and complete remission were obtained in 49.2%, 38.9% and 19.2% of
patients, respectively. Predictors of remission on-treatment in multivariate regression
analysis were adherence to therapy and remission induction during 6 months
after treatment. Predictors of remission off-treatment were age ≥40 at the time of
analysis and remission induction during 6 months after treatment. Poor outcome (SLE
Damage Index ≥1) was observed in 28% of the patients. Age at disease onset <30,
kidney and nervous system involvement and SLEDAI-2K ≥ 11 at the cohort entry
were the risk factors of poor outcome in multivariate analysis. However, sustained
remission on-treatment had a negative association with poor outcome.
Conclusion: Treatment with glucocorticoids, antimalarials, immunosuppressants and
biologics in sequential or in combination may cause durable remission. Patients with
durable remission have significantly lower organ damage. |