Failure to achieve lupus low disease activity state (LLDAS) six months after diagnosis is associated with early damage accrual in Caucasian patients with systemic lupus erythematosus

Abstract

Background: 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).

Methods: LLDAS 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.

Results: There 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).

Conclusion: LLDAS 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.

Keywords: Disease activity; Outcomes research; Systemic lupus erythematosus.

Fig. 1

Analysis of the main causes of lack of lupus low disease activity state (LLDAS) achievement. SLEDAI-2K, Systemic Lupus Erythematosus Disease Activity 2000; PGA, physician global assessment; PDN, prednisolone (or equivalent)

Fig. 2

Patients who were in lupus low disease activity state (LLDAS) and patients who were not in LLDAS (no-LLDAS) at 18 months (T2). Persistent LLDAS, patients who were in LLDAS at 6 months (T1) and at T2; No-LLDAS → LLDAS, patients who achieved LLDAS within the T1–T2 interval; Persistent no-LLDAS, patients who never achieved LLDAS; No-LLDAS ← LLDAS, patients who were in LLDAS at T1 but not at T2

Fig. 3

Frequency (percentage) of manifestations still identified at 18 months (T2) and respective remission rate. Purple, frequency (percentage) of manifestations recorded at T0 and still present at T2. Dark blue, manifestations that were in remission at 6 months (T1). Light blue, manifestations that were recorded as in remission for the first time at T2. Below the bars the global remission rate is reported