LBA:01:16 Predictors of flares in systemic lupus erythematosus patients after they had achieved remission. Data from the Almenara lupus cohort

Objectives Flares may still occur after remission, affecting organ damage accrual and survival expectancy. Therefore, identifying predictors of these flares is clinically relevant, particularly in Mestizo patients, for whom such evidence remains scarce. The aim of this study was to evaluate potential predictors of flares in primarily Mestizo SLE patients after they had achieved remission.Methods Data from a single-center prevalent Latin American SLE cohort were examined. The DORIS definition of remission was used as an entry criteria: a clinical SLEDAI-2K (excluding serology) = 0, prednisone less or equal than 5 mg/day, stable maintenance immunosuppression doses and/or biologic therapy, and physician global assessment (PGA) < 0.5. Flare was defined as an increase in SLEDAI-2K of at least 4 points (excluding those flares based only on serology). Potential predictors included sociodemographic characteristics, clinical variables (including SLEDAI-2K, SLICC/ACR damage index [SDI], PGA (per 0.1 increase) and the age-adjusted Charlson Comorbidity Index [ACCI]) and treatments. Univariable and multivariable regression analyses (stepwise selection procedure, alpha to stay in the model of 0.05) were used to identify independent predictors of flares.Results A total of 434 SLE patients who have at least presented remission once were included, contributing 1,547 visits during their follow-up; 93.1% were female, 97.9% were Mestizo, with a mean disease duration of 8.0 (6.8) years. The mean PGA was 0.05 (0.1), the mean SDI 1.4 (1.6) and the mean ACCI 1.5 (1.5). The mean prednisone dose was 3.2 (2.2) mg/day. During follow-up, 88 flares occurred (5.6% of all visits). In the multivariable analyses, higher PGA scores (HR 1.22; 95% CI 1.01–1.48; p=0.002), neuropsychiatric involvement (HR 1.89; 95% CI 1.20-2.98; p=0.006), African-Latin American ethnicity (HR 15.73; 95% CI 3.83–64.63; p