Frequency and predictors of the lupus low disease activity state in a multi-national and multi-ethnic cohort.

Vera Golder,Sean O’Neill,Mandana Nikpour,Chak Sing Lau,Alfred Lok Lee,Molla Huq,Zhan Guo Li,Sargunan Sockalingam,Mo Yin Mok,Madelynn Chan,Kate Franklyn,Fiona Goldblatt,Worawit Louthrenoo,Aisha Lateef,Yuan An,Shue Fen Luo,Leonid Zamora,Laniyati Hamijoyo,Rangi Kandane‐Rathnayake ,Eric F Morand ,Alberta Hoi ,S Navarra ,Yeong‐Jian Jan Wu ,S Morton

doi:10.1186/s13075-016-1163-2

Abstract

BackgroundSystemic lupus erythematosus (SLE) is a chronic heterogeneous disease with considerable burden from disease activity and damage. A novel clinical treatment target in the form of the lupus low disease activity state (LLDAS) has been recently reported, with retrospective validation showing that time spent in LLDAS translates to reduced damage accrual. The objectives of this study were to describe the frequency and identify the predictors of attaining LLDAS in a large multinational cohort of patients with SLE.MethodsData were collected at the recruitment visit in patients with SLE enrolled in a longitudinal study in nine countries. Data were analysed cross-sectionally against the recently published definition of LLDAS, and the frequency and characteristics associated with presence of LLDAS were determined. Stepwise multivariable logistic regression was used to determine predictors of LLDAS.ResultsOf the 1846 patients assessed, criteria for LLDAS were met by 44 %. Patients with shorter disease duration were less likely to be in LLDAS (OR 0.31, 95 % CI 0.19–0.49, p < 0.001). Likewise, patients with a history of discoid rash (OR 0.66, 95 % CI 0.49–0.89, p = 0.006), renal disease (OR 0.60, 95 % CI 0.48–0.75, p < 0.001), elevated double stranded DNA (OR 0.65, 95 % CI 0.53–0.81, p < 0.001) or hypocomplementaemia (OR 0.52, 95 % CI 0.40–0.67, p < 0.001) were less likely to be in LLDAS. When countries were compared, higher national social wealth (OR 1.57, 95 % CI 1.25–1.98, p < 0.001) as measured by the gross domestic product per capita was positively associated with LLDAS, but ethnicity was not.ConclusionThe lupus low disease activity state is observed in less than half of patients with SLE at a single point in time. Disease duration and phenotype, and national social wealth, are predictive of LLDAS.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-016-1163-2) contains supplementary material, which is available to authorized users.

Highlights

Systemic lupus erythematosus (SLE) is a chronic heterogeneous disease with considerable burden from disease activity and damage
The operational definition of lupus low disease activity state (LLDAS) is fulfilled when all of the following criteria are met: (1) SLE Disease Activity Index (SLEDAI-2 K) ≤4, with no activity in major organ systems (renal, central nervous system (CNS), cardiopulmonary, vasculitis, fever) and no haemolytic anaemia or gastrointestinal activity; (2) no new features of lupus disease activity compared to the previous assessment; (3) a Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA)-Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) physician global assessment (PGA) ≤1; (4) a current prednisolone dose ≤7.5 mg daily; and (5) well-tolerated standard maintenance doses of immunosuppressive drugs and approved biologic agents, excluding investigational drugs
In a retrospective cohort analysis, Franklyn et al showed that patients who spent greater than 50 % of their disease duration in LLDAS accrued significantly less damage compared to patients who did not [11], suggesting this definition has a role in the identification of treatment responses associated with improved long-term outcomes

Summary

Introduction

Systemic lupus erythematosus (SLE) is a chronic heterogeneous disease with considerable burden from disease activity and damage. A novel clinical treatment target in the form of the lupus low disease activity state (LLDAS) has been recently reported, with retrospective validation showing that time spent in LLDAS translates to reduced damage accrual. The Asia-Pacific Lupus Collaboration has recently developed and retrospectively validated the lupus low disease activity state (LLDAS) definition [11]. In a retrospective cohort analysis, Franklyn et al showed that patients who spent greater than 50 % of their disease duration in LLDAS accrued significantly less damage compared to patients who did not [11], suggesting this definition has a role in the identification of treatment responses associated with improved long-term outcomes

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