Pos1508 prevalence of remission according to physician and patient and level of agreement in a real-world multicenter lupus registry

Background Improvement on health-related quality of life (HRQoL) in patients with Systemic Lupus Erythematosus (SLE) remains a challenge. There is limited data on the level of agreement on remission according to physician and patient and remission impact on HRQoL and long-term outcomes. Objectives To investigate the prevalence and level of agreement between remission according to physician and patient criteria and to evaluate the impact of remission on HRQoL in patients with SLE. Methods Prospective study of patients included in RELESSER-PROS, a multicenter register of SLE patients. Protocol of the register has been previously described [1]. Remission according to physician was defined in agreement with DORIS 2021 criteria: clinical SLEDAI 0, physician global assessment ≤2 on a 0-10 Likert scale (equivalent to ≤0.5 on a 0-3 scale), stable low-dose prednisone (≤5mg) and stable immunosuppressive/ biologic agents if remission on therapy. Remission according to patient was defined as SLAQ (Systemic Lupus Activity Questionnaire) question 1 with no flare in the last 3 months (score 0). Patients were classified in three groups according to remission status by DORIS, SLAQ or both. Level of agreement was assessed using kappa statistics. Acceptable level of agreement was considered if kappa >0.60. Results 1102 patients, with a follow-up of at least 2 years (data from 3 visits available) were included in this analysis. Patient characteristics according remission status at baseline are presented in the Table 1. At baseline, remission by DORIS was present in 16.1%, by SLAQ 16.7% and 2.45% by both. Remission by DORIS was more frequent among patients with higher education, on immunosuppressant and biological therapy and patients with history of hospitalization; remission by SLAQ was more frequent among women, obese patients, and those on antimalarials (p<0.05). Symptoms reported in patients who considered themselves in remission were mainly cutaneous and articular (53.3%). Mean SLEDAI in patients on remission by SLAQ was 3.28 (3.78). Patients in remission by DORIS had significantly better results in patient reported outcomes (PRO) measured by EQ-5D and LIT (p<0.05). Level of agreement in remission according to physician and patient was 78.04% (k=0.061) at baseline, 63.39% (k=0.039), and 62.73% (k=0.099) in year 2 and 5 respectively. Kappa level of agreement was low. Conclusion Our results reflect low level of agreement between physician and patients in terms of remission status with increasing disagreement in the follow-up. Patients in remission by DORIS shows better results in EQ-5D and LIT. Reference [1] Rúa-Figueroa I, et al. Reumatol Clin. 2014;10(1):17-24. Table 1. Patient characteristics according remission status at baseline Remission by DORIS (n=177) Remission by SLAQ (n=184) Remission by both criteria (n=27) p-value Age at diagnosis (years), mean (SD) 34.6 (14.87) 36.64 (13.74) 33.77 (13.12) 0.181 Female sex, n (%) 160/176 (90.9%) 166/182 (91.2%) 27/27 (100%) 0.004 Disease duration (yrs), mean (SD) 15.26 (8.18) 13.71 (7.7) 19.8 (7.66) 0.069 Highest education 57/172 (33.1%) 40/180 (22.2%) 13/26 (50%) <0.001 Medication, n (%) Off-therapy Antimalarials Immunosuppressants (AZA, MTX, MMF) Biological therapy (rituximab, belimumab) 0/177 (0%) 79/176 (44.9%) 63/175 (36%) 14/176 (8%) 36/182 (19.8%) 100/182 (54.9%) 36/180 (20%) 8/178 (4.5%) 0/27 (0%) 14/27 (51.9%) 12/27 (44.4%) 4/27 (14.8%) 1 <0.001 <0.001 <0.001 Obesity (BMI>30), n (%) 18/162 (11.1%) 44/176 (25%) 3/24 (12.5%) 0.003 Hospital admission, n (%) 57/176 (32.4%) 40/182 (22%) 7/26 (26.9%) <0.001 SLEDAI, mean (SD) 1.66 (1.66) 3.28 (3.78) 1.78 (1.5) <0.001 SLAQ, mean (SD) 26.15 (2.55) 27.98 (1.81) 27.63 (1.96) <0.001 EQ-5D 67.53 (19.31) 63.22 (20.12) 64.54 (17.7) 0.041 LIT 26.68 (21.76) 34.37 (20.34) 31.3 (18.34) 0.0007 SLICC/ACR Damage Index 1.57 (1.74) 1.42 (1.84) 1.37 (1.9) 0.437 Mortality 0/177 (0%) 0/184 (0%) 0/27 (0%) 1 AZA azathioprine, MTX methotrexate, MMF mycophenolate, BMI body mass index, EQ-5D EuroQol-5D, LIT lupus impact tracker Acknowledgements: NIL. Disclosure of Interests None Declared.