Abstract
ObjectiveTo investigate the frequency and determinants of achieving the lupus low disease activity state (LLDAS), and the effect of LLDAS attainment on disease flare and damage accrual in a prospective, single-center cohort of Chinese lupus patients.MethodsBaseline and follow-up data from consecutive patients at the Peking University First Hospital were collected from January 2017 to June 2020.ResultsA total of 185 patients were enrolled, with median (range) disease duration at enrolment of 2.3 (0.8–7.7) years, and median follow-up of 2.2 (1.0–2.9) years. By the end of the study, 139 (75.1%) patients had achieved LLDAS at least once; 82 (44.3%) patients achieved LLDAS for ≥ 50% of observations. Multivariable logistic regression analysis showed that 24-h urinary total protein (UTP; per g) (OR = 0.447, 95%CI [0.207–0.968], p = 0.041), serum creatinine (Scr; per 10 µmol/L) (OR = 0.72, 95%CI [0.52–0.99], p = 0.040), and C3 level (per 100 mg/L) (OR = 1.60, 95%CI [1.18–2.17], p = 0.003) at recruitment had independent negative associations with achieving LLDAS for ≥ 50% of observations. Kaplan–Meier analyses showed a significant reduction in flare rate with increased proportion of time in LLDAS. Attainment of LLDAS in at least 50% of observations was an independent protective factor for damage accrual (OR = 0.19, 95%CI [0.04–0.99], p = 0.049).ConclusionsIn this prospective Chinese cohort, LLDAS was an attainable goal in clinical practice. Nephritis-related markers (UTP and Scr) and C3 level at recruitment negatively influenced achievement of LLDAS. LLDAS achievement was significantly protective from flare and damage accrual.Key points• Low disease activity status (LLDAS) is an achievable target during SLE treatment in China. Urine protein, serum creatinine, and C3 level at recruitment independently affect LLDAS achievement in this group of Chinese lupus patients.• As a treatment target, LLDAS achievement has a highly protective effect for preventing flare and damage accrual, especially in case of achieving LLDAS for ≥ 50% of observations.• The present results further highlight the practical significance of treat-to-target principle in SLE management (T2T/SLE) and the needs for promoting the application of T2T/SLE in clinical practice as well as exploring the concrete implement strategy.
Highlights
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease, where treatment is typically long term or even lifelong
lupus low disease activity state (LLDAS), an outcome measure developed by the multinational Asia–Pacific Lupus Collaboration, has been validated retrospectively and prospectively to be associated with a reduced risk of organ damage in studies from Latin America, North America, Europe, and the Asia–Pacific region [6, 9, 24]
75.1% of the patients achieved LLDAS at least once and 44.3% were in LLDAS at least 50% of visits, which were comparable with other reports [7, 25] and confirmed that LLDAS is an achievable goal, even in newly diagnosed patients who are more likely to have active disease [26]
Summary
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease, where treatment is typically long term or even lifelong. A recent study from the investigators’ center reported that the standardized mortality rate (SMR) of SLE patients in China compared to general population was 3.2 [1]; a meta-analysis of 15 studies comprising 26,101 SLE patients of various ethnicities revealed. The concept of T2T in SLE was relatively more recently proposed [3], with several “remission” or “low disease activity” states proposed by an expert task force as treatment targets [4]. With only one prospective validation study previously reported [6], the purpose of the present study was to investigate the frequency and determinants of achieving LLDAS, and the influence of LLDAS on disease flare and damage accrual in a single-center prospective longitudinal cohort of Chinese SLE patients
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