PREDICTORS OF FLARES AND LONG-TERM OUTCOME OF SYSTEMIC LUPUS-ERYTHEMATOSUS DURING COMBINED TREATMENT WITH AZATHIOPRINE AND LOW-DOSE PREDNISOLONE

Many patients with systemic lupus erythematosus (SLE) receive long-ter m treatment with azathioprine and prednisolone to control disease acti vity. In a retrospective study we evaluated the efficacy of combined t reatment with azathioprine (2 mg/kg body weight/d) and low-dose predni solone (7-12 mg/d) and the predictors of disease flares during this th erapy regimen in 61 patients with SLE. We found three predictors of fl ares: renal disease, persistence of dsDNA antibodies for at least 1 ye ar after the beginning of treatment and reduction in azathioprine dosa ge to below 2 mg/kg/d. The occurrence of flares was significantly asso ciated with a higher rate of disease-related death. Furthermore, the p ersistence of dsDNA antibodies for at least 2 years was associated wit h progression of renal disease. We concluded that suppression of produ ction of dsDNA antibodies with high avidity is a suitable parameter to determine efficacy of treatment and long-term outcome during combined therapy with azathioprine and low-dose prednisolone in SLE.