The time it takes for patients with systemic lupus erythematosus to achieve remission greatly depends on how remission is defined, and such episodes are usually short-lasting, according to an analysis of more than 2,000 patients in the Hopkins Lupus Cohort.
“Our results concerning durability of remission show the relapsing-remitting nature of SLE [systemic lupus erythematosus]. The median duration of remission was only about 3 months for all [four] definitions [used in the study]. This was the time to the next quarterly cohort visit. Even though achieving remission was frequent, durable remission was rare,” wrote the authors, led by Theresa R. Wilhelm, MD, of Johns Hopkins University in Baltimore.
Dr. Wilhelm and her coauthors chose to examine remission in SLE based on four DORIS (Definitions Of Remission In SLE) working group clinical definitions: clinical remission, complete remission, clinical ROT (Remission on Treatment), and complete ROT. To define them, a clinical SLE Disease Activity Index (cSLEDAI) score of 0 and a Physician Global Assessment of less than 0.5 were applicable to all definitions. Zero prednisone was applicable to clinical and complete remission, while clinical ROT and complete ROT allowed for 5 mg or less daily. Immunosuppressive drugs were not allowed for a patient to be deemed in either clinical or complete remission, but were allowed for both ROT definitions. Serologically negative results were deemed permissible for both complete remission and ROT, but not for clinical remission or clinical ROT (Ann Rheum Dis. 2016 Aug 24. doi: 10.1136/annrheumdis-2016-209489).
For a total of 2,307 SLE patients who were enrolled into the Hopkins Lupus Cohort during 1987-2014, the median time for clinical remission to be achieved was 8.7 years, while complete remission took 11.0 years, clinical ROT took 1.8 years, and complete ROT took 3.1 years. These Kaplan-Meier estimates of the distribution of time to remission after entry into the cohort did not include patients who had a gap in their follow-up or dropped out before satisfying the definition of remission.
However, across all four definitions, the median length of remission was only 3 months, as sustained remission proved elusive. Those with high disease activity and greater treatment had longer median times to achieve remission than did those with low disease activity and less treatment.
“Not surprisingly, we found that the level of baseline treatment and baseline disease activity were strongly associated with the time to remission for all definitions,” Dr. Wilhelm and her coauthors noted.
“Testing definitions of remission is of great relevance for clinical practice, as much as for clinical trials,” the authors concluded. “Our future goal is to find out which definitions are most successful in predicting the best possible outcome for our patients.”
The Hopkins Lupus Cohort receives funding from the National Institutes of Health. Dr. Wilhelm and her coauthors did not report any relevant financial disclosures.