Antiphospholipid antibody (aPL) is commonly present in SLE patients. We tried to identify the impact of persistent presence of aPL on target achievement in a real-world SLE cohort.
Records of our Peking University First Hospital SLE cohort from 2007 to 2019 were retrospectively reviewed. Patients were divided into SLE with persistent aPL and no-persistent aPL group in general, and 3 subgroups were further separated from the former, namely SLE with APS, SLE with at least two aPLs positivity, and SLE with persistent aPL yet delayed HCQ use. The attainment of LLDAS or remission, and relevant components in each patient group were analyzed by Cox proportional hazards model in propensity-score matched and unmatched cohorts.
626 SLE patients with 9415 visits were included in the study. Time to first LLDAS achievement was significantly longer in those with overlapping APS. After balancing confounders, overlapping APS and persistent aPL yet delayed HCQ initiation were associated with 61%, 77% lower probability of reaching LLDAS, and 48%, 84% lower probability of reaching clinical RONT. While the hazardous impact of persistent presence of aPL and at least two aPLs positivity was limited to serologic normalization. Both persistent aPL and its three subgroups hampered immunosuppressant discontinuation with HRs 0.82-0.51. Moreover, the harm of delayed HCQ initiation in the first 6 months was robust throughout all the relevant components.
Persistent aPL hampered SLE patients from reaching normal serology, while overlapping APS and delayed HCQ initiation in the first 6 months further exacerbated the difficulty of reaching remission and LLDAS.