AB0449 IMPACT OF REMISSION AND LOW DISEASE ACTIVITY (LDA) ON HEALTH-RELATED QUALITY OF LIFE (HRQOL) IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) PATIENTS: A SYSTEMATIC LITERATURE REVIEW (SLR)

Abstract

Background:Treat-to-target strategy has been proposed in SLE. Achieving remission/LDAS should prevent damage, reduce mortality and improve HRQoL.Objectives:To determine the protective value of remission or LDA states on HRQoL in SLE using a SLR.Methods:Two independent reviewers identified studies in Medline and Cochrane library and extracted data on remission, LDA and HRQoL. Remission and LDA definitions included disease activity (SLEDAI and its variants, SLAM and PGA), serological activity, new organ/system, prednisone (PDN) dose (mg/day), immunosuppressives (IS) drugs, antimalarial (AM) use and remission duration. The quality of the studies was assessed with the Newcastle-Otawa Scale (NOS).Results:Three manuscripts (1059 patients) for remission and 4 (2385 patients) for LDA were included (America, Europe & Asia Pacific). All the studies reached seven out of nine NOS points. Remission rates ranged 25-39%; and LDA: 42-62%. Even less stringent remission or LDA definitions predicted/were associated with a better HRQoL. Physical rather than mental domains were more associated with remission or LDA.Table 1.Association between remission and HRQoLAuthorsCountry/RegionPatientsRemissionRemission (%)Domains positively associated or predicted by remissionMok et al*China769SLEDAI=0Serologic= AllowedPGA<0.5PDN ≤ 5IS=YesAM=YesDuration≥5years25.1Remission>5 years vs not on remissionSF-36:Role physical, bodily pain, general health, vitality, social functioning, role emotional, PCS and MCSLupusPRO:Symptoms, medications, procreation, physical health, pain, emotional, image, HRQoL totalTsang-A-Sjoe et al#Netherlands154SLEDAI=0Serologic= allowedPGA ≤2/10PDN ≤ 5IS=YesAM=YesDuration=NR39.0 at baselineRemission on- or off-therapy predicted a better SF-36 PCS but not MCSMargiotta et al*Italy136SLEDAI=0Serologic= allowedPGA= NRPDN ≤ 5IS=YesAM=YesDuration>5 years39.0Remission >5years vs unremitted or remission<5 yearsSF-36:Physical health, role physical, bodily pain, general health, social functioningPCS: Physical component summary. MCS: Mental component summary. *Cross-sectional #LongitudinalTable 2.Association between LDA and HRQoLAuthorsCountry/RegionPatientsLDALDA (%)Domains positively associated or predicted by LDASGolder et al*Asia Pacific1422SLEDAI≤ 4PGA≤ 1PDN ≤ 7.5IS=YesAM=YesNew manifestations: NoDuration=NR42.0SF-36:Role physical, bodily pain, general health, vitality, social functioning, role emotional, mental health, PCS and MCSUgarte-Gil et al#USA483SLAM≤ 3PGA=NRPDN ≤ 7.5IS=NoAM=YesNew manifestations: NRDuration=NRNRSF-36:Physical function, role physical, bodily pain, general health, vitality, social functioning, role emotional, mental health, PCS and MCSUgarte-Gil et al#Peru243SLEDAI≤ 4PGA=NRPDN ≤ 7.5IS=YesAM=YesNew manifestations: NRDuration=NR48.6 at baselineLupusQoLPhysical health, pain, planning, burden to others, emotional health, fatiguePoomsalood et al*Thailand237SLEDAI≤ 2Serologic= allowedPGA=NRPDN ≤ 7.5IS=YesAM=YesNew manifestations: NRDuration=NR61.6SLEQoLUnivariable:physical, activities, symptom, treatment, mood, self-image and total.Multivariable: Better global QoLPCS: Physical component summary. MCS: Mental component summary. *Cross-sectional #LongitudinalConclusion:In SLE patients, achieving remission or LDA, is associated with a better HRQoL.Disclosure of Interests:Manuel F. Ugarte-Gil Grant/research support from: Jannsen, Pfizer, Claudia Mendoza Pinto: None declared, Cristina Reategui Sokolova: None declared, Guillermo Pons-Estel Grant/research support from: JANSSEN and GSK, Consultant of: JANNSEN, GSK and SANOFI, Speakers bureau: PFIZER, JANNSEN and GSK, Ronald van Vollenhoven Grant/research support from: AbbVie, Arthrogen, Bristol-Myers Squibb, GlaxoSmithKline, Lilly, Pfizer, and UCB, Consultant of: AbbVie, AstraZeneca, Biotest, Bristol-Myers Squibb, Celgene, GSK, Janssen, Lilly, Medac, Merck, Novartis, Pfizer, Roche, and UCB, George Bertsias Grant/research support from: GSK, Consultant of: Novartis, Graciela S Alarcon: None declared, Bernardo Pons-Estel Grant/research support from: GSK, Janssen, Consultant of: GSK, Janssen, Speakers bureau: GSK, Janssen