Pos1051 Glucocorticoid-Free Remission in Patients With Sle in the Era of Biologics: Immune Complex Disease Is Likely to Benefit From Current Medications

Background: In addition to various immunosuppressive agents, belimumab and anifrolumab became available in Japan. Objectives: We aimed to investigate glucocorticoid-free clinical remission in a single-centre retrospective cohort in October 2023. Methods: Our cohort included patients with SLE who needed to start or increase glucocorticoids for disease activity and were followed up for more than one year. We investigated the rate of achievement of clinical remission off corticosteroids (CR off C), defined as no clinical score on the SLEDAI-2K without glucocorticoids 1, whereas the achievement of CR on C (clinical SLEDAI=0, allowing the use of prednisolone (PSL) 5 mg plus other immunosuppressive drugs, HCQ, and biologic agents) and complete remission (CR, SLEDAI=0, not allowing the use of immunosuppressive drugs and serological activities) was also evaluated. We also determined baseline predictors of CR off C, medications used when CR off C was achieved, and flare rates following CR off C. Results: Out of the 60 patients followed for an average of 5.4 (±2.6) years, 17 (28.3%) achieved CR off C in 3.6 (±1.2) years after enrolment. Use of belimumab and anifrolumab accounted for eight (47.1%) of the achievers. Among the baseline data, male sex, recent enrolment, high glucocorticoid dose, and detection of immune complex (IC) significantly predicted CR off C, while lupus nephritis (LN) and a low C3 level were likely predictors, albeit insignificantly. In the multivariate analysis, IC detection was the only predictor of CR off C. Clinical flares were observed in 5.9% of the patients during a median 1.2 years after achievement of CR off C. Conclusion: In the era of biologics, CR off C was achieved in 28.3% of the patient cohort requiring the start or increase of glucocorticoids for disease activity, with a relatively low rate of flares, suggesting that glucocorticoid-free clinical remission is an achievable target in SLE. IC disease, represented by male sex or nephritis, is likely to benefit from currently available medications. REFERENCES: 1 Zen M, Iaccarino L, Gatto M, et al. Prolonged remission in Caucasian patients with SLE: prevalence and outcomes. Ann Rheum Dis 2015;74:2117-2222. Acknowledgements: The authors would like to thank the medical staff in our hospital and all participants of this study. Disclosure of Interests: Hiroshi Oiwa I have received speaking fees from GSK, Astra-Zeneca, Asahi-kasei, Astellas, Taisho, Eisai, Pfizer, Eli Lilly, Abbvie, Ayumi, Chugai, and Boehringer Ingelheim., Takeshi Suga: None declared, Yohei Hosokawa: None declared, Kei Araki: None declared.