Prevalence and predictors of flare after immunosuppressant discontinuation in patients with systemic lupus erythematosus in remission

Prevalence and predictors of flare after immunosuppressant discontinuation in patients with systemic lupus erythematosus in remission

Abstract Objectives Patients with SLE are often exposed to prolonged immunosuppression since few data on flare recurrence in remitted patients who discontinued immunosuppressants are available. We aimed to assess the rate and predictors of flare after immunosuppressant withdrawal in SLE patients in...

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Veröffentlicht in:Rheumatology (Oxford, England) England), 2020-07, Vol.59 (7), p.1591-1598
Hauptverfasser: Zen, Margherita, Saccon, Francesca, Gatto, Mariele, Montesso, Giulia, Larosa, Maddalena, Benvenuti, Francesco, Iaccarino, Luca, Doria, Andrea
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container_end_page 1598
container_issue 7
container_start_page 1591
container_title Rheumatology (Oxford, England)
container_volume 59
creator Zen, Margherita
Saccon, Francesca
Gatto, Mariele
Montesso, Giulia
Larosa, Maddalena
Benvenuti, Francesco
Iaccarino, Luca
Doria, Andrea
description Abstract Objectives Patients with SLE are often exposed to prolonged immunosuppression since few data on flare recurrence in remitted patients who discontinued immunosuppressants are available. We aimed to assess the rate and predictors of flare after immunosuppressant withdrawal in SLE patients in remission. Methods SLE patients diagnosed between 1990 and 2018 (according to the ACR criteria), ever treated with immunosuppressants and currently in follow-up were considered. Immunosuppressant discontinuation was defined as complete withdrawal of any immunosuppressive drug. Reasons for discontinuation were remission, defined as clinical SLEDAI-2K = 0 on a stable immunosuppressive and/or antimalarial therapy and/or on prednisone ⩽5 mg/day, or poor adherence/intolerance. Flares were defined according to the SLEDAI Flare Index. Predictors of a subsequent flare were analysed by multivariate logistic regression. Results There were 319 eligible patients out of 456 (69.9%). Of the 319 patients, 139 (43.5%) discontinued immunosuppressants, 105 (75.5%) due to remission, 34 (24.5%) due to poor adherence/intolerance. The mean (s.d.) follow-up time after immunosuppressant withdrawal was 91 (71) months (range 6–372). Among the patients who discontinued immunosuppressants, 26/105 remitted (24.7%) and 23/34 unremitted patients (67.6%) experienced a flare (P < 0.001) after a median (range) follow-up of 57 (6–264) and 8 months (1–72), respectively (P = 0.009). In patients who discontinued immunosuppressants due to remission, maintenance therapy with antimalarials (OR 0.243, 95% CI 0.070, 0.842) and the duration of remission at immunosuppressant discontinuation (OR 0.870, 0.824–0.996) were independent protective factors against disease flare. Conclusion SLE flares are not uncommon after immunosuppressant discontinuation, even in remitted patients; however, antimalarial therapy and durable remission can significantly reduce the risk of flare.
doi_str_mv 10.1093/rheumatology/kez422
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We aimed to assess the rate and predictors of flare after immunosuppressant withdrawal in SLE patients in remission. Methods SLE patients diagnosed between 1990 and 2018 (according to the ACR criteria), ever treated with immunosuppressants and currently in follow-up were considered. Immunosuppressant discontinuation was defined as complete withdrawal of any immunosuppressive drug. Reasons for discontinuation were remission, defined as clinical SLEDAI-2K = 0 on a stable immunosuppressive and/or antimalarial therapy and/or on prednisone ⩽5 mg/day, or poor adherence/intolerance. Flares were defined according to the SLEDAI Flare Index. Predictors of a subsequent flare were analysed by multivariate logistic regression. Results There were 319 eligible patients out of 456 (69.9%). Of the 319 patients, 139 (43.5%) discontinued immunosuppressants, 105 (75.5%) due to remission, 34 (24.5%) due to poor adherence/intolerance. The mean (s.d.) follow-up time after immunosuppressant withdrawal was 91 (71) months (range 6–372). Among the patients who discontinued immunosuppressants, 26/105 remitted (24.7%) and 23/34 unremitted patients (67.6%) experienced a flare (P &lt; 0.001) after a median (range) follow-up of 57 (6–264) and 8 months (1–72), respectively (P = 0.009). In patients who discontinued immunosuppressants due to remission, maintenance therapy with antimalarials (OR 0.243, 95% CI 0.070, 0.842) and the duration of remission at immunosuppressant discontinuation (OR 0.870, 0.824–0.996) were independent protective factors against disease flare. Conclusion SLE flares are not uncommon after immunosuppressant discontinuation, even in remitted patients; however, antimalarial therapy and durable remission can significantly reduce the risk of flare.</description><identifier>ISSN: 1462-0324</identifier><identifier>EISSN: 1462-0332</identifier><identifier>DOI: 10.1093/rheumatology/kez422</identifier><language>eng</language><publisher>Oxford University Press</publisher><ispartof>Rheumatology (Oxford, England), 2020-07, Vol.59 (7), p.1591-1598</ispartof><rights>The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com 2019</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c321t-5684ec8bf2f7d15adad0da93503542c1cf0765b4c55afa6f9447411bcc7b7ea13</citedby><cites>FETCH-LOGICAL-c321t-5684ec8bf2f7d15adad0da93503542c1cf0765b4c55afa6f9447411bcc7b7ea13</cites><orcidid>0000-0003-0548-4983</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1584,27924,27925</link.rule.ids></links><search><creatorcontrib>Zen, Margherita</creatorcontrib><creatorcontrib>Saccon, Francesca</creatorcontrib><creatorcontrib>Gatto, Mariele</creatorcontrib><creatorcontrib>Montesso, Giulia</creatorcontrib><creatorcontrib>Larosa, Maddalena</creatorcontrib><creatorcontrib>Benvenuti, Francesco</creatorcontrib><creatorcontrib>Iaccarino, Luca</creatorcontrib><creatorcontrib>Doria, Andrea</creatorcontrib><title>Prevalence and predictors of flare after immunosuppressant discontinuation in patients with systemic lupus erythematosus in remission</title><title>Rheumatology (Oxford, England)</title><description>Abstract Objectives Patients with SLE are often exposed to prolonged immunosuppression since few data on flare recurrence in remitted patients who discontinued immunosuppressants are available. We aimed to assess the rate and predictors of flare after immunosuppressant withdrawal in SLE patients in remission. Methods SLE patients diagnosed between 1990 and 2018 (according to the ACR criteria), ever treated with immunosuppressants and currently in follow-up were considered. Immunosuppressant discontinuation was defined as complete withdrawal of any immunosuppressive drug. Reasons for discontinuation were remission, defined as clinical SLEDAI-2K = 0 on a stable immunosuppressive and/or antimalarial therapy and/or on prednisone ⩽5 mg/day, or poor adherence/intolerance. Flares were defined according to the SLEDAI Flare Index. Predictors of a subsequent flare were analysed by multivariate logistic regression. Results There were 319 eligible patients out of 456 (69.9%). Of the 319 patients, 139 (43.5%) discontinued immunosuppressants, 105 (75.5%) due to remission, 34 (24.5%) due to poor adherence/intolerance. The mean (s.d.) follow-up time after immunosuppressant withdrawal was 91 (71) months (range 6–372). Among the patients who discontinued immunosuppressants, 26/105 remitted (24.7%) and 23/34 unremitted patients (67.6%) experienced a flare (P &lt; 0.001) after a median (range) follow-up of 57 (6–264) and 8 months (1–72), respectively (P = 0.009). In patients who discontinued immunosuppressants due to remission, maintenance therapy with antimalarials (OR 0.243, 95% CI 0.070, 0.842) and the duration of remission at immunosuppressant discontinuation (OR 0.870, 0.824–0.996) were independent protective factors against disease flare. Conclusion SLE flares are not uncommon after immunosuppressant discontinuation, even in remitted patients; however, antimalarial therapy and durable remission can significantly reduce the risk of flare.</description><issn>1462-0324</issn><issn>1462-0332</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNqNkDtPwzAUhSMEEqXwC1g8srT1K0k7ooqXVAkGmCPXuaaGxA6-Nqjs_G9cFSFGpvs639XRKYpzRqeMLsQsbCD1KvrOP29nr_ApOT8oRkxWfEKF4Ie_PZfHxQniC6W0ZGI-Kr4eAryrDpwGolxLhgCt1dEHJN4Q06mQ9yZCILbvk_OYhixBVC6S1qL2LlqXVLTeEevIkDtwEcmHjRuCW4zQW026NCQkELZxAzufmKesDvmImNHT4sioDuHsp46Lp-urx-XtZHV_c7e8XE204CxOymouQc_Xhpu6ZaVqVUtbtRAlFaXkmmlD66pcS12WyqjKLKSsJWNrret1DYqJcXGx_zsE_5YAY5MNaOg65cAnbLigc1YzKassFXupDh4xgGmGYHsVtg2jzS705m_ozT70TE33lE_Dv4BviA-QgA</recordid><startdate>20200701</startdate><enddate>20200701</enddate><creator>Zen, Margherita</creator><creator>Saccon, Francesca</creator><creator>Gatto, Mariele</creator><creator>Montesso, Giulia</creator><creator>Larosa, Maddalena</creator><creator>Benvenuti, Francesco</creator><creator>Iaccarino, Luca</creator><creator>Doria, Andrea</creator><general>Oxford University Press</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0548-4983</orcidid></search><sort><creationdate>20200701</creationdate><title>Prevalence and predictors of flare after immunosuppressant discontinuation in patients with systemic lupus erythematosus in remission</title><author>Zen, Margherita ; Saccon, Francesca ; Gatto, Mariele ; Montesso, Giulia ; Larosa, Maddalena ; Benvenuti, Francesco ; Iaccarino, Luca ; Doria, Andrea</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c321t-5684ec8bf2f7d15adad0da93503542c1cf0765b4c55afa6f9447411bcc7b7ea13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zen, Margherita</creatorcontrib><creatorcontrib>Saccon, Francesca</creatorcontrib><creatorcontrib>Gatto, Mariele</creatorcontrib><creatorcontrib>Montesso, Giulia</creatorcontrib><creatorcontrib>Larosa, Maddalena</creatorcontrib><creatorcontrib>Benvenuti, Francesco</creatorcontrib><creatorcontrib>Iaccarino, Luca</creatorcontrib><creatorcontrib>Doria, Andrea</creatorcontrib><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Rheumatology (Oxford, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zen, Margherita</au><au>Saccon, Francesca</au><au>Gatto, Mariele</au><au>Montesso, Giulia</au><au>Larosa, Maddalena</au><au>Benvenuti, Francesco</au><au>Iaccarino, Luca</au><au>Doria, Andrea</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevalence and predictors of flare after immunosuppressant discontinuation in patients with systemic lupus erythematosus in remission</atitle><jtitle>Rheumatology (Oxford, England)</jtitle><date>2020-07-01</date><risdate>2020</risdate><volume>59</volume><issue>7</issue><spage>1591</spage><epage>1598</epage><pages>1591-1598</pages><issn>1462-0324</issn><eissn>1462-0332</eissn><abstract>Abstract Objectives Patients with SLE are often exposed to prolonged immunosuppression since few data on flare recurrence in remitted patients who discontinued immunosuppressants are available. We aimed to assess the rate and predictors of flare after immunosuppressant withdrawal in SLE patients in remission. Methods SLE patients diagnosed between 1990 and 2018 (according to the ACR criteria), ever treated with immunosuppressants and currently in follow-up were considered. Immunosuppressant discontinuation was defined as complete withdrawal of any immunosuppressive drug. Reasons for discontinuation were remission, defined as clinical SLEDAI-2K = 0 on a stable immunosuppressive and/or antimalarial therapy and/or on prednisone ⩽5 mg/day, or poor adherence/intolerance. Flares were defined according to the SLEDAI Flare Index. Predictors of a subsequent flare were analysed by multivariate logistic regression. Results There were 319 eligible patients out of 456 (69.9%). Of the 319 patients, 139 (43.5%) discontinued immunosuppressants, 105 (75.5%) due to remission, 34 (24.5%) due to poor adherence/intolerance. The mean (s.d.) follow-up time after immunosuppressant withdrawal was 91 (71) months (range 6–372). Among the patients who discontinued immunosuppressants, 26/105 remitted (24.7%) and 23/34 unremitted patients (67.6%) experienced a flare (P &lt; 0.001) after a median (range) follow-up of 57 (6–264) and 8 months (1–72), respectively (P = 0.009). In patients who discontinued immunosuppressants due to remission, maintenance therapy with antimalarials (OR 0.243, 95% CI 0.070, 0.842) and the duration of remission at immunosuppressant discontinuation (OR 0.870, 0.824–0.996) were independent protective factors against disease flare. Conclusion SLE flares are not uncommon after immunosuppressant discontinuation, even in remitted patients; however, antimalarial therapy and durable remission can significantly reduce the risk of flare.</abstract><pub>Oxford University Press</pub><doi>10.1093/rheumatology/kez422</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-0548-4983</orcidid></addata></record>
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title Prevalence and predictors of flare after immunosuppressant discontinuation in patients with systemic lupus erythematosus in remission
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