Pos1483 is early remission a predictive factor for steroid-free remission in systemic lupus erithematosus? a real-life experience from a monocentric cohort

Background Glucocorticoid (GC) dose minimization and, if possible, complete withdrawal is one of the main targets in the daily management of Systemic Lupus Erythematosus (SLE). Objectives to describe frequency and clinical characteristics of SLE patients in GC-free remission in a real-life setting and to identify predictive factors for achieving GC-free remission. Methods this is a retrospective analysis of prospectively collected data from a monocentric SLE cohort. The following variables were retrieved: demographic data, cumulative organ involvement; at last observation: disease activity (SLEDAI-2K score), ongoing therapy, disease state (remission defined according to the 2021 DORIS criteria) and organ damage (SDI score). Disease state at 1 year from disease onset was also recorded. Results from our cohort, a total of 390 SLE patients had at least 1 year of follow-up and complete clinical data to be included in the analysis; of these, 142 (36.4%) were in GC-free remission at the last evaluation, and 44 (11.3%) were GC-free for 5 years (Table 1). The mean follow-up duration was 10.5 years (min 1-max 41). No significant differences were found with regard to age at disease onset, disease duration and organ involvement between the GC-free remission group (GC-) and the other SLE patients under GC treatment (GC+). Patients GC- were less frequently taking immunosuppressants (IS) (28.9%, vs 43.5% p<0.01) or biological drugs (6.3% vs 20.2% p<0.01) and were more frequently under HCQ treatment (85.2% vs 75.8%, p=0.03) at last observation. Being GC- at last observation was associated with a significantly lower organ damage with respect to GC+ (mean SDI 0.7 vs 1.5, p<0.01); significant differences regarded cardiovascular (CV) events (4.9% vs 12.1%, p=0.01) and osteoporosis (OP) (12.7% vs 27.0%, p<0.01) were also found. Overall, 212 patients were in remission after 1 year from disease onset (78.2% in GC- and 57.2% in the GC+) and this condition resulted significantly associated with GC-free remission at last evaluation (p<0.01). At multivariate analysis, being in remission at 1 year resulted an independent predictor of GC-free remission (OR=2.06, p=0.02); the multivariate analysis also confirmed that GC- patients were less likely on IS or biological treatment at last evaluation (OR 0.46 p<0,01 and OR 0.20 p<0.01, respectively). Conclusion these data suggest that GC-free remission is an achievable goal in SLE patients with today’s drugs, and in our cohort GC-free remission is also a IS-free remission in most of patients. Our study also confirms that GC withdrawal has important advantages in term of organ-damage sparing. Of note, the early achievement of remission during the disease history is associated with a good probability of GC withdrawal over time. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests None Declared.