Is Remission Now an Achievable Goal for More Patients with Systemic Lupus Erythematosus?

Abstract

More than 3.4 million people worldwide are affected by systemic lupus erythematosus (SLE), a chronic, complex, and unpredictable autoimmune condition that can take years to diagnose. SLE, the most common form of lupus, frequently has a profoundly negative impact on the quality of life for patients, with many reporting chronic fatigue, anxiety, and pain as symptoms. Inadequate disease control, and associated side effects of current treatment for people with SLE, lead to recurrent flares in symptoms and high risk of organ damage. Fifty percent of people with SLE have irreversible organ damage within 5 years of diagnosis due to long-term oral glucocorticoid (GC) use, disease flares, and persistent disease activity. SLE mortality remains unacceptably high and is one of the top 10 causes of death in young women in the USA. Although the speed of innovation has accelerated in recent years, there is still a great need beyond symptom management to tackle the underlying cause of the disease and achieve clinical remission for patients. In 2023, the European Alliance of Associations for Rheumatology (EULAR) updated its recommendations for SLE management, elevating the importance of treating to target remission or low disease activity with elimination of steroids, where possible, to reduce the risk of organ damage and adverse outcomes in patients. EULAR defines remission in SLE, according to the Definition of Remission in SLE (DORIS) criteria, as having no disease activity while receiving treatment, but GC ≤5 mg/day. Two leading SLE experts, Ian Bruce, Queen’s University Belfast, UK, and Julia Weinmann-Menke, Medical Center of the Johannes Gutenberg University, Mainz, Germany, discuss why remission is now a realistic goal in SLE, and how aiming for early and sustained remission can help to improve patient outcomes and address urgent unmet medical needs.