PO:15:209 | Attainment of remission or lupus low disease activity state in single center Lupus Clinic

Paola Tedoldi^1|2, Silvia Ebe Lucia Della Pina^1|2, Claudia Barison^1|2, Chiara Orlandi^1|2, Cecilia Nalli¹, Micaela Fredi², Ilaria Cavazzana^1|2, Franco Franceschini^1|2 | ¹Rheumatology and Clinical Immunology Unit- ERN ReCONNET, ASST Spedali Civili of Brescia Brescia, Italy; ²Department of Clinical and Experimental Sciences, University of Brescia Brescia, Italy

Purpose. In SLE an early diagnosis and treatment advances have resulted in improved outcomes, and it is well known that management should aim at remission of disease symptoms and signs and, when it is not possible, to a low-disease activity state. Data from literature indicate that 45–70% of patients may achieve remission, while ~80% of patients may reach low disease activity(1). Moreover, even if low dosage of glucocorticoids(GC) is admitted into the definition of remission/LLDAS, the most recent management recommendations have proposed as target the withdrawal of GC(2). The aim of the study was to evaluate the prevalence of patients that met the definition of DORIS remission and/or LLDAS at the last evaluation. We have also evaluated patients that met the DORIS criteria still receiving 5mg/day of GC, exploring the rationale for ongoing treatment.

Materials and Methods. We examined 401 medical charts of patients affected by SLE, who reached our Lupus Clinic from January 2023 to May 2025. Disease activity, cumulative organ damage and remission were recorded according to validated indices such as SLEDAI-2K, SLICC Damage Index, LLDAS and DORIS at the last available visit. GC, HCQ, DMARDS, biological therapies were also evaluated at the same time point. Categorical variables were reported as number/percentage, continuous variables were expressed as mean (±standard deviation) values.

Results. Among 401 patients, 370(92.3%) were females and 362(90.3%) were Caucasian; mean age at diagnosis was 31 years(±12.7), with a mean disease duration of 20 years(±12.6). Cumulative clinical and serological manifestations are reported in Table1. At the last visit mean SLEDAI-2K was 1.3(±1.9) and 51.1% received GC at a mean daily dose of 4.4mg(±3.4), 81.2% HCQ, 50.1% DMARDs, and 23.4% biological therapies. 350(87.3%) reached the LLDAS, while 314(78.3%) met the DORIS criteria. Characteristics of patients in remission or not are detailed in Table2. Notably, patients meeting DORIS criteria showed less biologics(p=0.002), longer disease duration(p=0.02) and lower SLICC-SDI(p=0.0055). Among patients who did not achieve DORIS remission, 13(14.9%) required GC>5mg/day; 48(55.2%) had cSLEDAI>0, 10(11.5%) exhibited both cSLEDAI>0 and GC>5mg/day. Lastly, 14(16.1%) showed a Physician Global Assessment score>0.5. Among patients in remission, 23(7.3%) were still receiving 5mg/day of GCs. Of these, 3(13%) were tapering GC following a recent flare, 12(52.2%) couldn’t reduce the dose due to symptom recurrence, 6(26.1%) had no recent tapering attempts and 2(12.7%) continued GC for other indications.

Conclusions. A substantial proportion of long-standing SLE achieved DORIS remission, associated with longer disease duration, lower organ damage, and reduced use of CGs and biologics. Persistent low-dose GC therapy in some patients highlights the complexity of tapering strategies and suggest that formal remission does not always coincide with complete steroid withdrawal. Personalized management remains essential to optimize long-term outcomes. (1)Sanchèz et al,Rheumathology,2023 (2)Arnaud et al,Rheumathology,2020