Abstract
BackgroundThe aim was to assess the attainability and outcome of the lupus low disease activity state (LLDAS) in the early stages of systemic lupus erythematosus (SLE).MethodsLLDAS prevalence was evaluated at 6 (T1) and 18 (T2) months after diagnosis and treatment initiation (T0) in a monocentric cohort of 107 (median disease duration 9.7 months) prospectively followed Caucasian patients with SLE. Reasons for failure to achieve LLDAS were also investigated. Multivariate models were built to identify factors associated with lack of LLDAS achievement and to investigate the relationship between LLDAS and Systemic Lupus International Collaboration Clinics (SLICC)/Damage Index (SDI) accrual.ResultsThere were 47 (43.9%) patients in LLDAS at T1 and 48 (44.9%) at T2. The most frequent unmet LLDAS criterion was prednisolone dose >7.5 mg/day (83% of patients with no LLDAS at T1). Disease manifestations with the lowest remission rate during follow up were increased anti-double-stranded DNA (persistently present in 85.7% and 67.5% of cases at T1 and T2, respectively), low serum complement fractions (73.2% and 66.3%) and renal abnormalities (46.4% and 28.6%). Renal involvement at T0 was significantly associated with failure to achieve LLDAS both at T1 (OR 7.8, 95% CI 1.4–43.4; p = 0.019) and T2 (OR 3.9, 95% CI 1.4–10.6; p = 0.008). Presence of any organ damage (SDI ≥1) at T2 was significantly associated with lack of LLDAS at T1 (OR 5.0, 95% CI 1.5–16.6; p = 0.009) and older age at diagnosis (OR 1.05 per year, 95% CI 1.01–1.09; p = 0.020).ConclusionLLDAS is a promising treatment target in the early stages of SLE, being attainable and negatively associated with damage accrual, but it fit poorly to patients with renal involvement.
Highlights
The aim was to assess the attainability and outcome of the lupus low disease activity state (LLDAS) in the early stages of systemic lupus erythematosus (SLE)
LLDAS is based on the following criteria: (1) SLE Disease Activity Index 2000 (SLEDAI-2K) ≤4, with no activity in major organ systems; (2) no new lupus disease activity compared with the previous assessment; (3) Safety of Estrogen in Lupus Erythematosus National Assessment (SELENA)-SLEDAI physician global assessment (PGA) ≤1; (4) current prednisolone dose ≤7.5 mg daily; and (5) well-tolerated standard maintenance doses of immunosuppressive drugs and approved biological agents [13]
In a cross-sectional study, increased anti-dsDNA, renal involvement, low complement shorter disease duration and history of discoid rash were identified as negatively associated with LLDAS [15]. These findings suggest that renal involvement and serological abnormalities are associated with a lower likelihood of LLDAS achievement
Summary
The aim was to assess the attainability and outcome of the lupus low disease activity state (LLDAS) in the early stages of systemic lupus erythematosus (SLE). An international task force has recently suggested applying the T2T strategy in SLE, recommending that the treatment target should be remission or, where this cannot be reached, the lowest possible disease activity [9]. LLDAS is based on the following criteria: (1) SLE Disease Activity Index 2000 (SLEDAI-2K) ≤4, with no activity in major organ systems (renal, central nervous system, cardiopulmonary, vasculitis, gastrointestinal, haemolytic anaemia fever); (2) no new lupus disease activity compared with the previous assessment; (3) Safety of Estrogen in Lupus Erythematosus National Assessment (SELENA)-SLEDAI physician global assessment (PGA) ≤1; (4) current prednisolone (or equivalent) dose ≤7.5 mg daily; and (5) well-tolerated standard maintenance doses of immunosuppressive drugs and approved biological agents [13]
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