TREAT-TO-TARGET ATTAINMENT IN PATIENTS WITH SLE FROM THE REUMA.PT SLE REGISTRY: A MULTICENTER PORTUGUESE CROSS-SECTIONAL STUDY OF 795 PATIENTS
Notice bibliographique
Résumé
PV215 / #526 Poster Topic: AS23 - SLE-Diagnosis, Manifestations, & Outcomes Background/Purpose Treat-to-target (T2T) aiming for remission, or at least low disease activity (LDA), while tapering prednisone to ≤5 mg/day is established as a pillar for management of systemic lupus erythematosus (SLE) in the 2023 updated EULAR recommendations for clinical practice. The aim of our study was to investigate the attainment of the T2T goal in the SLE population from the Rheumatic Diseases Portuguese Registry (Reuma.pt) and identify unmet treatment needs. Methods We performed a cross-sectional multicenter study of patients fulfilling the EULAR/ACR 2019 classification criteria for SLE in the Reuma.pt. The assessment was performed at the last visit occurring between June 2023 and March 2024. Disease activity and attainment of T2T were assessed with the SLE Disease Activity Score (SLE-DAS).[1] Patients with no SLE-DAS scoring were excluded. Patients were classified as in remission (clinical items of SLE-DAS =0 and prednisone ≤5 mg/day), low disease activity (LDA) (SLE-DAS ≤2.48 and prednisone ≤5 mg/day) and, for those not attaining T2T, in categories of disease activity (mild: 2.08<SLE-DAS≤7.64; moderate: 7.64<SLE-DAS≤9.90; severe: SLE-DAS>9.90). Descriptive analysis was performed, and a comparison between the remission vs. non-remission and LDA vs. non-LDA groups was performed using Student’s t-test, Fisher’s exact test, Chi-square or Mann-Whitney U tests, as appropriate. IBM SPSS Statistics software version 27 was used. p≤0.05 was considered statistically significant. Results There were 2459 patients with SLE from 37 centers registered in Reuma.pt. Of these, 1664 (67.7%) were excluded due to: missing data on fulfillment (n=1257, 51.1%) or no fulfillment (n=83, 3.4%) of EULAR/ACR classification criteria; missing data for SLE-DAS (n=324, 13.2%). A total of 795 patients from 18 participating centers were included [89.6% female; mean age 49.9 (SD 14.2) years] (Table 1). Main cumulative SLE clinical features included: mucocutaneous (72.5%), hematological (66.7%), arthritis (63.6%), nephritis (38.9%), serositis (19.4%) and neuropsychiatric lupus (6.8%). Remission was attained by 71.3% and an additional 3.0% were in LDA, meaning that the EULAR treatment target was achieved by 74.3%. The remaining patients presented active disease (mild 20%, moderate 2.6%, severe 3%). Hydroxychloroquine (HCQ) was prescribed to 88.3% of all patients. Patients not in LDA were more frequently treated with synthetic (69.1% vs 39.6%, p<0.001) and biologic (19.1% vs 8.5%, p<0.001) immunosuppressants. Of the patients with active SLE, 40.2% were receiving >7.5 mg/day of prednisolone-equivalent dose and 72.7% were treated with synthetic and/or biologic immunosuppressants. Table 1. Characteristics of the patients included (n=795). Conclusions This subgroup of patients with SLE registered in Reuma.pt present a high rate of attainment of the T2T, and most are treated with HCQ, in line with the EULAR recommendations. The high number of patients excluded preclude the generalization of these conclusions. This provides benchmarking indicators demonstrating high quality of care. Furthermore, unmet needs for new and improved therapies are demonstrated, with over a quarter of patients presenting active disease despite more intensive standard-of-care. Longitudinal studies are needed to assess if T2T goals are sustained over time. Optimized treatment regimens are needed to attain recommended T2T goals in many SLE patients. Improvement of registry in Reuma.pt is indispensable for a representative national appraisal. References: [1.] Jesus D. Ann Rheum Dis 2021;80(12):1568-74. * Carolina Mazeda and Beatriz Mendes contributed equally and share first authorship.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».