Remission and clinical patterns of systemic lupus erythematosus (SLE) in Pakistan: a retrospective cohort study

ObjectivesPrimary objective was to investigate clinical features and biomarkers associated with severe systemic lupus erythematosus (SLE). The secondary objective was to identify patterns of SLE remission. MethodsA retrospective study of 200 SLE patients (2014-20) from ImmunoCure Center was conducted. Patients fulfilled ACR criteria 1997 for SLE classification. SLEDAI-2K categories mild-moderate (score <=10) and severe (score >10) were used as outcome for the primary objective. Predictors of severe SLE were evaluated by multivariate logistic regression analysis. For the secondary objective, we evaluated 94 records with follow-up time >1year. Remission status (Yes/No) was based on DORIS criteria. Survival regression was performed using Kaplan Meier curve. ResultsSignificant predictors of severe SLE were male gender (OR 4.1; 95% CI: 1.2, 13.5), oral ulcers (OR 6.9; 95% CI: 2.8, 17.1), alopecia (OR 2.1; 95% CI 1.0-4.1), nephritis (OR 4.5; 95% CI: 1.9-11.4), ESR >30mm/hour (OR 2.3; 95% CI: 1.2-4.4) and aCL antibodies (OR 2.4, 95% CI 1.0 -5.9). The mean duration of follow-up was 41{+/-}19 months. Remission on treatment was achieved in 66% of 94 patients, while off treatment in 21% with a mean post-remission follow-up of 18{+/-}15 months. For every one-month increase in the duration of follow-up, the hazard of time to remission increased by 4% (95% CI 0.95-0.98; P<0.001). Factor analysis identified 4 SLE subtypes. ConclusionA clinical model including aCL antibodies is presented here that predicts severe SLE. Remission is possible even in severe SLE in LMIC with adequate immunosuppression and persistent follow-up.