Gao Dai, Ji Lanlan, Zhang Xiaohui, Hao Yanjie, Xie Wenhui, Fan Yong, Zhang Zhuoli
Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China.
National Clinical Research Center for Skin and Immune Diseases, Peking University First Hospital, Beijing, China.
Front Immunol. 2025 Mar 20;16:1546306. doi: 10.3389/fimmu.2025.1546306. eCollection 2025.
To identify predictors and barriers to achieving remission in systemic lupus erythematosus (SLE) patients after attaining Lupus Low Disease Activity State (LLDAS).
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.
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, =0.002), arthritis (HR 1.481, 95%CI=1.113-1.969, =0.007), and gastrointestinal involvement (HR 1.994, 95%CI=1.230-3.232, =0.005). Conversely, anemia (HR 0.564, 95%CI=0.428-0.743, <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, <0.001) or the Physician's Global Assessment (HR 0.062, 95%CI=0.031-0.127, <0.001) and the presence of rash (HR 0.156, 95%CI=0.049-0.499, =0.002), anti-dsDNA positivity (HR 0.513, 95%CI=0.403-0.654, <0.001), hypocomplementemia (HR 0.468, 95%CI=0.346-0.632, <0.001), or thrombocytopenia (HR 0.138, 95%CI=0.051-0.377, <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, =0.013) or cyclophosphamide (HR 3.468, 95%CI=1.959-6.141, <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.
Achieving rapid remission after LLDAS attainment remains challenging for most SLE patients, mainly due to difficulties in reducing prednisone dosage to ≤5 mg/day.
确定系统性红斑狼疮（SLE）患者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。
本研究纳入了来自Sle到TARget（STAR）队列中基线时未达到LLDAS的患者。采用Kaplan-Meier方法估计达到LLDAS后缓解或疾病复发的累积概率。使用单变量和多变量Cox比例风险模型确定缓解时间的预测因素。还对阻碍实现缓解的障碍进行了调查。
在586名登记患者中，480名在20.4个月内（四分位间距13.4 - 37.1）达到LLDAS。其中，369名未与达到LLDAS同时实现缓解且仍在进行随访的患者被纳入进一步分析。随后，297名（80.5%）患者实现缓解，缓解和疾病复发的中位时间分别为12.4个月和24.4个月。缓解时间较短的独立预测因素包括发病时年龄较大（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，P < 0.001）是一个风险预测因素。由2000年SLE疾病活动指数（HR 0.691，95%CI = 0.632 - 0.757，P < 0.001）或医生整体评估（HR 0.062，95%CI = 0.031 - 0.127，P < 0.001）定义的较高疾病活动度，以及达到LLDAS时出现皮疹（HR 0.156，95%CI = 0.049 - 0.499，P = 0.002）、抗双链DNA阳性（HR 0.513，95%CI = 0.403 - 0.
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