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Objectives To evaluate flares after sustained drug-free remission and their associated factors.Methods We studied SLE patients from a long-term longitudinal, multinational, multiethnic inception cohort; eligible patients were those who had >2 annual visits, who were not in remission at the baseline visit and who had achieved sustained drug-free remission during the follow-up. Sustained drug-free remission was defined as a SLEDAI-2K (excluding serology)=0, off prednisone and immunosuppressive drugs (IS) for two, three or five years; antimalarials were allowed. Flare, after achieving remission, was defined as any increase on the SLEDAI-2K (excluding serology) and/or the addition of prednisone and/or an IS during the follow-up. Potential predictors were sex, age at diagnosis, ethnicity, educational level, SLEDAI-2K domains and adjusted mean SLEDAI-2K from cohort entry to remission, baseline disease duration, time from baseline to remission, mean prednisone daily dose, IS and antimalarials from baseline to remission. Partially adjusted and multivariable Cox regression models were used, disease duration before remission was included in all models. Model 1 assessed sustained drug-free remission for at least two years, model 2 sustained drug-free remission for at least three years and model 3 for at least five years.Results 89 out of 183 (48.6%) patients who achieved remission for at least two years presented with a flare during follow-up; in patients with remission for at least three years flares were seen in 52 out of 123 (42.3%) and in those who achieved remission for at least five years in 25 out of 71 (35.2%). In the multivariable models, a shorter time to remission, the adjusted mean SLEDAI-2K and previous mucocutaneous involvement were associated with flares in those who achieved remission for at least two years, and previous renal involvement was associated with flares in those who achieved remission for at least three and five years ( tables 1 & 2).Abstract LBA:01:14 Table 1–2Conclusions Patients who achieve sustained drug-free remission remain at considerable risk for flares. Previous disease activity, renal and mucocutaneous involvement were associated with a higher probability of flare. The negative association between time to remission and risk of flare might reflect a need to improve the medication discontinuation strategies in SLE patients.