TREAT-TO-TARGET ATTAINMENT IN PATIENTS WITH SLE FROM THE REUMA.PT SLE REGISTRY: A MULTICENTER PORTUGUESE CROSS-SECTIONAL STUDY OF 795 PATIENTS

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 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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