A new study by Theresa R. Wilhelm, M.D., Laurence S. Magder Ph.D., and Michelle Petri, M.D., M.P.H. is the first to test four new, widely-agreed upon definitions of remission in SLE (DORIS definitions) in a large cohort of SLE patients, the Johns Hopkins Lupus Cohort. In general, remission refers to the relief from symptoms of a disease, but there are many definitions that include different criteria to define this state. The authors found that only very few patients with SLE reach durable remission, regardless of defining remission on-treatment or off-treatment. The higher the patients’ disease activity and treatment was when they entered the analysis, the lower their chance was of achieving remission.
Why was this study done?
How was this study done?
We applied the new DORIS definitions of remission in SLE to the Johns Hopkins Lupus Cohort with over 2000 patients, to find out how many patients fulfill the different definitions, how long it takes patients to reach remission, how long it lasts, and if there are any patient characteristics that predict who will reach remission. Patients in this cohort are usually seen by a doctor several times a year for their routine clinical care and were followed for several years. At each visit, a large amount of clinical information was collected, including information on SLE disease activity, and relevant blood tests. We then used statistical tools to calculate the time to remission, durability of remission, and predictors of remission.
What were the major findings?
We found that it is easier for patients to reach remission when certain treatments were still allowed (hydroxychloroquine, immunosuppressive drugs, prednisone ≤5 mg/day), than to reach remission off most treatments (just hydroxychloroquine allowed). We also found that the durability of remission is very short, only about 3 months, regardless of the definition used. The higher the patients’ disease activity and treatment was when they entered our analysis, the lower their chance was of achieving remission.
What is the impact of this work?
In this study, we learned that remission in SLE patients is short and that it is more difficult to achieve treatment-free remission than remission on certain medications. This is the first step to understanding which definition(s) of remission predict the best outcomes for our patients. To achieve this, we have to analyze our present treatment strategies and critically evaluate how our patients are doing in the long run. In particular, it is important to identify the patients in whom treatment can be tapered without flare, and in whom disease activity is merely suppressed by effective therapies.
This research was supported by:
The National Institutes of Health grant R01 AR 43727.
Link to original research article:
Remission in systemic lupus erythematosus: durable remission is rare. Wilhelm TR, Magder LS, Petri M. Ann Rheum Dis. 2016 Aug 24.