0327: SMART-SLE: Serology Monitoring and Repeat Testing in Systemic Lupus Erythematosus

Ai Li Yeo¹, Rangi Kandane-Rathnayake², Rachel Koelmeyer³, Vera Golder², Worawit Louthrenoo⁴, Yi-Hsin Chen⁵, Jiacai Cho⁶, Aisha Lateef⁷, Laniyati Hamijoyo⁸, Luo Shue Fen⁹, Yeong-Jian Wu⁹, Sandra Navarra¹⁰, Leonid Zamora¹¹, Zhanguo Li¹², An Yuan¹³, Sargunan Sockalingam¹⁴, Yasuhiro Katsumata¹⁵, Masayoshi Harigai¹⁵, Yanjie Hao¹⁶, Zhouli Zhang¹⁷, Duminda Basnayake¹⁸, Madelynn Chan¹⁹, Jun Kikuchi²⁰, Tsutomu Takeuchi²¹, Sang-Cheol Bae²², Shereen Oon²³, Sean O'Neill²⁴, Fiona Goldblatt²⁵, Kathy Gibson²⁴, Kristine Ng²⁶, Hui Nee Annie Law²⁷, Nicole Tugnet²⁸, Sunil Kumar²⁹, Cherica Tee³⁰, Michael Tee³⁰, Yoshiya Tanaka³¹, Naoaki Ohkubo³¹, Chak Sing³², Mandana Nikpour³³, Alberta Hoi³⁴, Michelle Leech³ and Eric Morand³⁵, ¹Monash Health and Monash University, Melbourne, Australia, ²Monash University, Clayton, Australia, ³Monash University, Melbourne, Australia, ⁴Chiang Mai University, Chiang Mai, Thailand, ⁵Taichung Veterans General Hospital, Taichung, Taiwan, ⁶National University Health System (NUHS), Singapore, Singapore, ⁷National University Hospital, Singapore, Singapore, ⁸Hasan Sadikin Hospital, Jakarta Selatan, Indonesia, ⁹Chang Gung Memorial Hospital, Taoyuan, Taiwan, ¹⁰University of Santo Tomas, Manila, Philippines, ¹¹University of Santo Tomas Hospital, Manila, Philippines, ¹²People's Hospital, Peking University Health Science Center, Beijing, China, ¹³Peking University Health Science Center, Beijing, China, ¹⁴University of Malaya, Kuala Lumpur, Malaysia, ¹⁵Division of Rheumatology, Department of Internal Medicine, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan, ¹⁶The University of Melbourne, Melbourne, Australia, ¹⁷Peking University First Hospital, Beijing, China, ¹⁸Teaching Hospital Kandy, Kandy, Sri Lanka, ¹⁹Tan Tock Seng Hospital, Singapore, Singapore, ²⁰Keio University, Tokyo, Japan, ²¹Keio University and Saitama Medical University, Tokyo, Japan, ²²Hanyang University Medical Center, Seoul, Republic of Korea, ²³St Vincent's Hospital, Fitzroy, Australia, ²⁴Liverpool Hospital, Sydney, Australia, ²⁵Flinders Medical Centre, Adelaide, Australia, ²⁶North Shore Hospital, Auckland, New Zealand, ²⁷Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore, ²⁸Greenlane Clinical Centre, Auckland, New Zealand, ²⁹Middlemore Hospital, Auckland, New Zealand, ³⁰University of the Philippines, Quezon City, Philippines, ³¹University of Occupational and Environmental Health, Kitakyusyu Fukuoka, Japan, ³²The University of Hong Kong, Pok Fu Lam, Hong Kong, ³³The University of Melbourne at St. Vincent's Hospital Melbourne, Melbourne, Australia, ³⁴Monash Health, Melbourne, Australia, ³⁵Monash University, Victoria; Department of Rheumatology, Monash Health, Melbourne, Australia

Background/Purpose: Disease monitoring in systemic lupus erythematosus (SLE) includes serial measurement of anti-double stranded-DNA (dsDNA) antibodies, but in patients who are persistently anti-dsDNA positive, the utility of repeated measurement is unclear. We investigated the usefulness of serial anti-dsDNA testing in predicting flare in SLE patients who are persistently anti-dsDNA positive.

Methods: Data were analysed from patients in a multinational longitudinal cohort who had at least two visits with anti-dsDNA results from 2013 to 2021. Patients were categorised based on their anti-dsDNA results as persistently negative, fluctuating or persistently positive. Cox regression models were used to examine longitudinal associations of anti-dsDNA results with flare.

Results: Data from 37,582 visits of 3,484 patients were analysed. 1,029 (29.5%) of patients had persistently positive anti-dsDNA and 1,195 (34%) had fluctuating results. Anti-dsDNA levels were associated with increased risk of subsequent flare in the cohort overall, and this was also observed in persistently positive patients with an adjusted hazards ratio (95% confidence interval) of 1.56 (1.30, 1.87) (p< 0.001). Increase or decrease in anti-dsDNA more than two-fold compared to the previous visit was associated with increased risk of flare both in the whole cohort (p< 0.001) and in persistently positive patients (p=0.009).

Conclusion: Absolute value and change in anti-dsDNA titers between visits predict flares, including in persistently anti-dsDNA positive patients.

Disclosures: A. Yeo, None; R. Kandane-Rathnayake, None; R. Koelmeyer, None; V. Golder, None; W. Louthrenoo, None; Y. Chen, None; J. Cho, None; A. Lateef, None; L. Hamijoyo, None; L. Fen, None; Y. Wu, None; S. Navarra, Biogen, Astellas, Janssen, Novartis, Pfizer, Boehringer-Ingelheim, GlaxoSmithKline (GSK); L. Zamora, None; Z. Li, None; A. Yuan, None; S. Sockalingam, None; Y. Katsumata, GlaxoSmithKline K.K., AstraZeneca K.K., Pfizer Japan Inc., Janssen Pharmaceutical K.K., Chugai Pharmaceutical Co., Ltd., Asahi Kasei Pharma, Sanofi K.K., Mitsubishi Tanabe Pharma Corporation, Astellas Pharma Inc.; M. Harigai, AbbVie Japan GK, Asahi Kasei Corp., Astellas Pharma Inc., Ayumi Pharmaceutical Co., Boehringer Ingelheim Japan, Inc., Bristol-Myers Squibb(BMS), Chugai Pharmaceutical Co., Ltd., Daiichi-Sankyo, Inc., Eisai Co., Ltd., Eli Lilly Japan K.K., Kaken Pharmaceutical Co., Ltd., Kissei Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Mochida Pharmaceutical Co., Ltd., Nippon Kayaku Co., Ltd., Nippon Shinyaku Co., Ltd., Pfizer Japan Inc., Taisho Pharmaceutical Co., Ltd., Teijin Pharma Ltd., UCB Japan Co., Ltd., Viatris Japan; Y. Hao, None; Z. Zhang, None; D. Basnayake, None; M. Chan, None; J. Kikuchi, None; T. Takeuchi, Astellas Pharma, Eli Lilly Japan, Gilead Sciences, AbbVie, Eisai Co., Ltd, Pfizer Japan Inc., Asahi Kasei, Chugai, Daiichi Sankyo, Dainippon Sumitomo Eisai, Mitsubishi-Tanabe, Shionogi, Takeda, UCB Japan, Ayumi Pharmaceutical Corporation, Bristol-Myers Squibb, Novartis, Sanofi; S. Bae, None; S. Oon, None; S. O'Neill, None; F. Goldblatt, None; K. Gibson, Eli Lilly Pty Ltd; K. Ng, None; H. Law, None; N. Tugnet, None; S. Kumar, None; C. Tee, None; M. Tee, None; Y. Tanaka, Lilly, AbbVie, Bristol Myers Squibb, Chugai, Daiichi Sankyo, Eisai, Pfizer, Mitsubishi Tanabe, GlaxoSmithKline, Asahi Kasei, Takeda, Astellas, Janssen, Novartis, Sanofi, UCB, YL Biologics, MSD, Ono, Taisho Toyama, Celltrion, Gilead, Boehringer-Ingelheim, Corrona, Kowa, Amgen, AstraZeneca, AstraZeneca, Eli Lilly; N. Ohkubo, None; C. Sing, None; M. Nikpour, Janssen, AstraZeneca, GlaxoSmithKlein(GSK), Boehringer-Ingelheim, Bristol-Myers Squibb(BMS); A. Hoi, None; M. Leech, None; E. Morand, AbbVie/Abbott, Amgen, AstraZeneca, Biogen, Bristol-Myers Squibb(BMS), Eli Lilly, Genentech, GlaxoSmithKlein(GSK), Janssen, Novartis, Servier, UCB, EMD Serono, Billerica, MA, USA.