Patients with lupus who achieve remission, LDA less likely to accrue systemic damage
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Patients with systemic lupus erythematosus who achieve remission, regardless of treatment status, or low disease activity are less likely to accrue as much systematic damage as those who do not reach treatment goals, according to data.
“This is the first study examining the independent impact of remission off-treatment and on-treatment, according to the Definition of Remission in SLE (DORIS) definition, and of low disease activity, according to the Toronto Cohort and to the Asia Pacific Lupus Collaboration definitions, on damage accrual in systemic lupus erythematosus patients,” Manuel Francisco Ugarte-Gil, MD, MSc, of the Hospital Nacional Guillermo Almenara Irigoyen, in Lima, Peru, told Healio. “To this end, we have evaluated patients from a large, multi-ethnic, multinational inception SLE cohort — the SLICC cohort.”
To investigate the different impacts of remission and LDA — based on various definitions — on patients with SLE, Ugarte-Gil and colleagues extracted and analyzed data from the Systemic Lupus International Collaborating Clinics (SLICC) cohort. The cohort draws from 33 sites in countries throughout Asia, Europe and North America, and includes patients recently diagnosed with SLE between 1999 and 2011. All included patients met the American College of Rheumatology’s revised SLE classification criteria and were enrolled in the cohort within 15 months of receiving a diagnosis.
Included patients had at least two registered visits and data available on disease activity, by way of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2K22; damage accrual, through the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI); and average medication dosage.
For the purposes of the analysis, disease activity states included remission off-treatment, defined as a cSLEDAI-2K of 0 with no prednisone or immunosuppressive drugs at the time of the visit; remission on-treatment, defined as a cSLEDAI-2K of 0 with prednisone doses of less than or equal to 5 mg per day and/or immunosuppressive drugs at maintenance dosages; low disease activity Toronto cohort (LDA-TC), defined as a cSLEDAI-2K of less than or equal to two without prednisone or immunosuppressive drugs; and modified lupus low disease activity (mLLDAS), defined as a SLEDAI-2K score of less than or equal to four with no activity in major organ systems and no new disease activity features compared with the previous assessment, and prednisone doses of 7.5 mg or less per day and/or immunosuppressive drugs at a maintenance dose.
The analysis included a total of 1,652 patients. The average age at diagnosis was 34.2 years, and the average follow-up time was 7.7 years. Each of the four disease activity states analyzed resulted in a lower incidence rate ratio of damage accrual. For patients who reached remission off treatment, the incidence rate ratio was 0.75 (95% CI, 0.7-0.81). In patients who reached remission on treatment, the ratio was 0.68 (95% CI, 0.62-0.75). Among patients achieving LDA-TC, the ratio was 0.79 (95% CI, 0.68-0.92) and in patients achieving mLLDAS, it was 0.76 (95% CI, 0.65-0.89).
“Remission, on-treatment and off-treatment, and low disease activity, according to both definitions, were associated with less damage accrual, even after adjustment for possible confounders and effect modifiers,” Ugarte-Gil said. “Whereas remission should be our ideal target this is not always possible; low disease activity constitutes the alternative target in such situations.
“We should strive for a single definition of remission and of low disease activity so that we can compare results between studies conducted around the world,” he added. “Furthermore, we should use these definitions as treatment goals, both in the clinical setting and in clinical trials.”
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