Journal Article

THU0340 Prolonged remission is associated with a reduced risk of cardiovascular disease in patients with systemic lupus erythematosus

Margiotta, D.P., Afeltra, A., Pierro, L., valentini, G., Fasano, S., Riccardi, A.

2018

Overview

BackgroundCardiovascular disease (CVD) has emerged as one of the most important causes of mortality in systemic lupus erythematosus (SLE)1. In previous studies, disease activity, as assessed by SLEDAI (at the first visit or as mean annual value registered during follow-up), did not result to have any predictive role on the subsequent occurrence of CVD2–3.ObjectivesTo investigate the relationship between prolonged remission and the occurrence of a subsequent first CV event in patients with SLE.MethodsOut of 452 patients consecutively admitted to two tertiary Italian centres from November 1st 2000 to December 31st 2016, the 409 patients, who, at admission, had not experienced any CV event, had not received any anticoagulation therapy and had been visited at least biannually during follow-up, were considered for the present study. Prolonged remission was defined as a 5 year consecutive period of no disease activity based on SLEDAI-2K3.. Patients with prolonged remission were furtherly subdivided according to Zen et al4 into 3 groups: complete remission, clinical off-corticosteroids remission (offCR), clinical on-corticosteroids remission (onCR). Kaplan-Meier curves and the log-rank test were used to analyse differences in event-free survival between groups. Cox regression analysis was used to investigate disease and therapeutic features associated with the development of a first CV event.ResultsDuring 72 months median follow-up time, 29 (7.0%) CV events occurred (two events in patients who had undergone prolonged remission). Out of the 409 patients, 28 patients (6.8%) achieved a prolonged complete remission, 13 (3.1%) prolonged clinical offCR and 64 (15.5%) prolonged clinical onCR. Kaplan-Meier analysis revealed a greater overall CV event-free rate in patients achieving a prolonged remission compared to those in remission but for less than 5 years and patients not in remission (logrank test χ2=19.82; p=0.0001; figure 1). However, at Kaplan-Meier analysis, CV outcome was similar among patients in prolonged remission, irrespective of the type of remission achieved (p>0.05). At multivariate analysis, treatment with hydroxychloroquine for more than 5 years and prolonged remission were protective (HR 0.38; 95% CI 0.16–0.90; HR 0.08, 95% CI 0.01–0.53) while antiphospholipid syndrome increased the risk of a first CV event (HR 3.80; 95% CI 1.68–8.61). No differences were found between patients treated or not with aspirin. Nevertheless, among patients from Rome cohort, aspirin was only prescribed to patients with high traditional CV risk score.ConclusionsA prolonged remission, whichever the subtype, is associated with a better CV outcome and should be considered as a treat-to-target goal in the CV risk management of the lupus patient.References[1] Cervera R, et al. Medicine (Baltimore)2003.[2] Iudici M, et al. Rheumatology (Oxford)2016.[3] Fasano S, et al. Lupus2017.[4] Zen M, et al. Ann Rheum Dis2017.Disclosure of InterestNone declared

• Publisher: Elsevier Limited
• Subject: Antiphospholipid syndrome / Aspirin / Cardiovascular disease / Cardiovascular diseases / Corticosteroids / Hydroxychloroquine / Lupus / Multivariate analysis / Patients / Remission / Systemic lupus erythematosus