Application of lupus comprehensive disease control in newly diagnosed systemic lupus erythematosus patients: results from the Italian multicentre Early Lupus Project inception cohort

OBJECTIVES: The concept of Comprehensive Disease Control (CDC) underlines as the control of disease activity should be associated with damage inhibition. Recently, this concept has been proposed in Systemic Lupus Erythematosus (SLE) patients (LupusCDC) with long-standing disease. In the present analysis we evaluated the incidence of LupusCDC in a cohort of newly diagnosed patients. METHODS: We analysed data from the multicentre cohort of the Early Lupus Project. Disease activity was evaluated by ECLAM and chronic damage by SDI. At each available time point, the presence of remission condition was assessed, defined as: Complete remission in GCs (GCon): ECLAM=0, antimalarials and/or immunosuppressants, PDN ≤5 mg/day; and Complete remission without GCs (GCoff): ECLAM=0, antimalarials and/or immunosuppressants. The presence of LupusCDC was analysed, defined as remission in the absence of progression of chronic damage (LupusCDC-GCon and LupusCDC-GCoff). RESULTS: We included 239 patients [205F; mean±DS age 45.8±14.6 years] with a follow-up of 36 months. During this period, 33.08% of patients achieved LupusCDC-GCon, while 12.03% LupusCDC-GCoff in at least one evaluation. Univariate analysis showed the association between failure to achieve LupusCDC-GCon and musculoskeletal manifestations (p<0.001), activity in renal and neuropsychiatric domains (p=0.01, p<0.001, respectively), association confirmed by the multivariate analysis. CONCLUSIONS: CDC in early onset SLE is not uncommon. Indeed, one-third of patients achieved LupusCDC-GCon in at least one evaluation. More severe disease, characterised by active renal and neuropsychiatric manifestations represented a risk factor for failure to achieve LupusCDC. The lower incidence of LupusCDC-GCoff suggested the difficulty in discontinuing GC treatment in early disease phase.