Frequency,predictors And Prognostic Benefits Of LLDAS And Remission In Systemic Lupus Erythematosus:a Multicenter Cohort Study In China

Objective:Based on the data platform of CSTAR,we established a large-scale,multicenter SLE LLDAS and remission cohort,aiming to describe the LLDAS and remission achievement in Chinese SLE patients,determine the predictors of these statuses,and explore the prognostic benefits of these targets on organ damage.Methods:This study was a retrospective,multicenter cohort study.SLE patients in the CSTAR registration platform who met the criteria for inclusion and exclusion were enrolled.Medical records were collected at baseline and each follow-up,including demographic characteristics and course of the disease,clinical manifestations,immunological characteristics,disease evaluation index,and medication.LLDAS and remission statuses were defined base on the framework proposed by APLC and DORIS.The frequency of LLDAS and remission achievement was described.Cox regression analysis and Logistic regression analysis were used to find the predictive factors of reaching these targets and explore the influence of these targets on organ damage.Results:A total of 496 patients were enrolled in the LLDAS cohort.During the follow-up,391(78.8%)patients achieved LLDAS at least once,and 179(36.1%)patients achieved LLDAS50.Patients who had ulcers[OR 0.554,95%CI(0.343-0.895),P=0.016]and renal involvement[OR 0.635,95%CI(0.426-0.948),P=0.026]were less likely to achieve LLDAS50.Patients who reached the LLDAS50 status had fewer new organ damages than those who did not[HR 0.395,95%CI(0.236-0.660),P<0.001].A total of 1163 patients were enrolled in the first-time remission study.During the follow-up,498(42.8%)people reached remission at least once.Patients were further divided into complete remission(4.2%),complete remission on treatment(56.6%),clinical remission(1.6%),clinical remission on treatment(37.6%).Baseline use of immunosuppressive agents[HR 1.978,95%CI(1.101-3.553),P=0.023],ulcers[HR 0.622,95%CI(0.446-0.868),P=0.005],alopecia[HR 0.767,95%CI(0.597-0.987),P=0.039],anti-dsDNA antibody positive[HR 0.757,95%CI(0.585-0.987),P=0.035]and hypocomplementemia[HR 0.701,95%CI(0.543-0.904),P=0.006]were associated with remission achievement.1183 patients were enrolled in the sustained remission study.During the follow-up,376 people achieved sustained remission,accounting for 31.8%of the total number.Patients were divided into sustained complete remission(4.0%),sustained complete remission on treatment(34.3%),sustained clinical remission(5.1%),sustained clinical remission group on treatment(56.6%).The sooner the patients achieved the remission state,the more likely they would reach subsequent sustained remission[OR 0.973,95%CI(0.951-0.995),P=0.018].Patients who reached the sustained remission status had fewer new organ damages than those who did not[HR 0.275,95%CI(0.174-0.435),P<0.001].Conclusion:This study is currently the largest LLDAS and remission study for Chinese SLE patients.The results showed that LLDAS and remission are achievable and desirable for Chinese lupus patients,which help reduce new organ damage.Clinicians should screen and intervene in the factors that affect target achievement and therefore prevent new organ damages.