. 2021 Nov;8(1):e000538.

doi: 10.1136/lupus-2021-000538.

2021 DORIS definition of remission in SLE: final recommendations from an international task force

Ronald F van Vollenhoven¹, George Bertsias², Andrea Doria³, David Isenberg⁴, Eric Morand⁵, Michelle A Petri⁶, Bernardo A Pons-Estel⁷, Anisur Rahman⁸, Manuel Francisco Ugarte-Gil⁹, Alexandre Voskuyl¹⁰, Laurent Arnaud^{11

12}, Ian N Bruce¹³, Ricard Cervera¹⁴, Nathalie Costedoat-Chalumeau¹⁵, Caroline Gordon¹⁶, Frédéric A Houssiau^{17

18}, Marta Mosca¹⁹, Matthias Schneider²⁰, Michael M Ward²¹, Graciela Alarcon²², Martin Aringer²³, Anka Askenase²⁴, Sang-Cheol Bae²⁵, Hendrika Bootsma²⁶, Dimitrios T Boumpas²⁷, Hermine Brunner²⁸, Ann Elaine Clarke²⁹, Cindy Coney³⁰, László Czirják³¹, Thomas Dörner³², Raquel Faria³³, Rebecca Fischer³⁴, Ruth Fritsch-Stork³⁵, Murat Inanc³⁶, Søren Jacobsen³⁷, David Jayne³⁸, Annegret Kuhn³⁹, Bernadette van Leeuw⁴⁰, Maarten Limper⁴¹, Xavier Mariette⁴², Sandra Navarra⁴³, Mandana Nikpour⁴⁴, Marzena Helena Olesinska⁴⁵, Guillermo Pons-Estel⁴⁶, Juanita Romero-Diaz⁴⁷, Blanca Rubio⁴⁰, Yehuda Schoenfeld⁴⁸, Eloisa Bonfá⁴⁹, Josef Smolen⁵⁰, Y K Onno Teng⁵¹, Angela Tincani⁵², Michel Tsang-A-Sjoe⁵³, Carlos Vasconcelos⁵⁴, Anne Voss^{55

56}, Victoria P Werth⁵⁷, Elena Zakharhova⁵⁸, Cynthia Aranow⁵⁹

Affiliations

¹ Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands r.vanvollenhoven@amsterdamumc.nl.
² Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Heraklion, Greece.
³ Division of Rheumatology, University of Padova, Padova, Italy.
⁴ Centre for Rheumatology, University College London, London, UK.
⁵ Monash Medical Centre, Melbourne, Victoria, Australia.
⁶ Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁷ Rheumatology, Provincial Hospital of Rosario, Rosario, Santa Fe, Argentina.
⁸ Medicine (Rheumatology), University College London, London, UK.
⁹ Rheumatology, Southern Scientific University, Lima, Peru.
¹⁰ VU University Medical Center, Amsterdam, The Netherlands.
¹¹ Department of Rheumatology, Strasbourg University Hospitals, Strasbourg, France.
¹² Strasbourg Federation of Translational Medicine (FMTS), University of Strasbourg, Strasbourg, France.
¹³ The University of Manchester, Manchester, UK.
¹⁴ Hospital Clinic of Barcelona, Barcelona, Spain.
¹⁵ Cochin Hospital, Paris, France.
¹⁶ Rheumatology Research Group, University of Birmingham, Birmingham, UK.
¹⁷ Pole of Rheumatic Pathologies, Catholic University of Louvain, Institute for Experimental and Clinical Research, Brussels, Belgium.
¹⁸ Rheumatology Department, Saint-Luc University Clinics, Brussels, Belgium.
¹⁹ University of Pisa, Pisa, Italy.
²⁰ Policlinic for Rheumatology & Hiller Research Centre for Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany.
²¹ NIH, Bethesda, Maryland, USA.
²² University of Alabama, Birmingham, Alabama, USA.
²³ Dresden University Hospital, Dresden, Germany.
²⁴ Columbia University Medical Center, New York, New York, USA.
²⁵ Rheumatology, Hanyang University Seoul Hospital, Seoul, Korea (the Republic of).
²⁶ UMC Groningen, Groningen, The Netherlands.
²⁷ Medicine, National and Kapodestrian University of Athens, Athens, Greece.
²⁸ Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
²⁹ University of Calgary, Calgary, Alberta, Canada.
³⁰ Lupus Foundation of America, Washington, District of Columbia, USA.
³¹ Department of Rheumatology and Immunology, University of Pecs, Pecs, Hungary.
³² Charite University Hospitals Berlin, Berlin, Germany.
³³ Clinical Immunology Unit, Porto Hospital and University Center, Porto, Portugal.
³⁴ Rheumatology, Heinrich-Heine-University, Duesseldorf, Germany.
³⁵ First Medical Department, Hanusch Hospital, Wien, Austria.
³⁶ Internal Medicine Rheumatology, University of Istanbul, Istanbul, Turkey.
³⁷ Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
³⁸ Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK.
³⁹ University of Meunster, Meunster, Germany.
⁴⁰ Lupus Europe, Brussels, Belgium.
⁴¹ Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands.
⁴² Public Assistance, Paris Hospitals, Paris Saclay University, Le Kremlin-Bicetre, France.
⁴³ Rheumatology, University of Santo Tomas Hospital, Manila, Philippines.
⁴⁴ Medicine and Rheumatology, University of Melbourne, Fitzroy, Victoria, Australia.
⁴⁵ Institute of Rheumatology, Warsaw, Poland.
⁴⁶ Regional Center for Autoimmune and Rheumatic Diseases (GO-CREAR), Rosario, Argentina.
⁴⁷ Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico.
⁴⁸ Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.
⁴⁹ Rheumatology, University of Sao Paulo Faculty of Medicine, Sao Paulo, Brazil.
⁵⁰ Medical University of Vienna, Wien, Austria.
⁵¹ Nephrology, Leiden University Medical Centre, Leiden, The Netherlands.
⁵² Rheumatology, University of Brescia, Brescia, Italy.
⁵³ Rheumatology, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands.
⁵⁴ Unit for Multidisciplinary Research in Biomedicine, Porto, Portugal.
⁵⁵ Department of Rheumatology, Odense University Hospital, Odense, Denmark.
⁵⁶ Department of Clinical Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark.
⁵⁷ Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁵⁸ Rheumatology, A I Yevdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of the Russian Federation Faculty of Dentistry, Moskva, Russian Federation.
⁵⁹ Autoimmune and Musculoskeletal Disease, The Feinstein Institute for Medical Research, Manhasset, New York, USA.

PMID: 34819388
PMCID: PMC8614136
DOI: 10.1136/lupus-2021-000538

2021 DORIS definition of remission in SLE: final recommendations from an international task force

Ronald F van Vollenhoven et al. Lupus Sci Med. 2021 Nov.

. 2021 Nov;8(1):e000538.

doi: 10.1136/lupus-2021-000538.

Authors

Affiliations

¹ Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands r.vanvollenhoven@amsterdamumc.nl.
² Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Heraklion, Greece.
³ Division of Rheumatology, University of Padova, Padova, Italy.
⁴ Centre for Rheumatology, University College London, London, UK.
⁵ Monash Medical Centre, Melbourne, Victoria, Australia.
⁶ Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁷ Rheumatology, Provincial Hospital of Rosario, Rosario, Santa Fe, Argentina.
⁸ Medicine (Rheumatology), University College London, London, UK.
⁹ Rheumatology, Southern Scientific University, Lima, Peru.
¹⁰ VU University Medical Center, Amsterdam, The Netherlands.
¹¹ Department of Rheumatology, Strasbourg University Hospitals, Strasbourg, France.
¹² Strasbourg Federation of Translational Medicine (FMTS), University of Strasbourg, Strasbourg, France.
¹³ The University of Manchester, Manchester, UK.
¹⁴ Hospital Clinic of Barcelona, Barcelona, Spain.
¹⁵ Cochin Hospital, Paris, France.
¹⁶ Rheumatology Research Group, University of Birmingham, Birmingham, UK.
¹⁷ Pole of Rheumatic Pathologies, Catholic University of Louvain, Institute for Experimental and Clinical Research, Brussels, Belgium.
¹⁸ Rheumatology Department, Saint-Luc University Clinics, Brussels, Belgium.
¹⁹ University of Pisa, Pisa, Italy.
²⁰ Policlinic for Rheumatology & Hiller Research Centre for Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany.
²¹ NIH, Bethesda, Maryland, USA.
²² University of Alabama, Birmingham, Alabama, USA.
²³ Dresden University Hospital, Dresden, Germany.
²⁴ Columbia University Medical Center, New York, New York, USA.
²⁵ Rheumatology, Hanyang University Seoul Hospital, Seoul, Korea (the Republic of).
²⁶ UMC Groningen, Groningen, The Netherlands.
²⁷ Medicine, National and Kapodestrian University of Athens, Athens, Greece.
²⁸ Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
²⁹ University of Calgary, Calgary, Alberta, Canada.
³⁰ Lupus Foundation of America, Washington, District of Columbia, USA.
³¹ Department of Rheumatology and Immunology, University of Pecs, Pecs, Hungary.
³² Charite University Hospitals Berlin, Berlin, Germany.
³³ Clinical Immunology Unit, Porto Hospital and University Center, Porto, Portugal.
³⁴ Rheumatology, Heinrich-Heine-University, Duesseldorf, Germany.
³⁵ First Medical Department, Hanusch Hospital, Wien, Austria.
³⁶ Internal Medicine Rheumatology, University of Istanbul, Istanbul, Turkey.
³⁷ Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
³⁸ Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK.
³⁹ University of Meunster, Meunster, Germany.
⁴⁰ Lupus Europe, Brussels, Belgium.
⁴¹ Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands.
⁴² Public Assistance, Paris Hospitals, Paris Saclay University, Le Kremlin-Bicetre, France.
⁴³ Rheumatology, University of Santo Tomas Hospital, Manila, Philippines.
⁴⁴ Medicine and Rheumatology, University of Melbourne, Fitzroy, Victoria, Australia.
⁴⁵ Institute of Rheumatology, Warsaw, Poland.
⁴⁶ Regional Center for Autoimmune and Rheumatic Diseases (GO-CREAR), Rosario, Argentina.
⁴⁷ Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico.
⁴⁸ Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.
⁴⁹ Rheumatology, University of Sao Paulo Faculty of Medicine, Sao Paulo, Brazil.
⁵⁰ Medical University of Vienna, Wien, Austria.
⁵¹ Nephrology, Leiden University Medical Centre, Leiden, The Netherlands.
⁵² Rheumatology, University of Brescia, Brescia, Italy.
⁵³ Rheumatology, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands.
⁵⁴ Unit for Multidisciplinary Research in Biomedicine, Porto, Portugal.
⁵⁵ Department of Rheumatology, Odense University Hospital, Odense, Denmark.
⁵⁶ Department of Clinical Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark.
⁵⁷ Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁵⁸ Rheumatology, A I Yevdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of the Russian Federation Faculty of Dentistry, Moskva, Russian Federation.
⁵⁹ Autoimmune and Musculoskeletal Disease, The Feinstein Institute for Medical Research, Manhasset, New York, USA.

PMID: 34819388
PMCID: PMC8614136
DOI: 10.1136/lupus-2021-000538

Erratum in

Correction: 2021 DORIS definition of remission in SLE: final recommendations from an international task force.
[No authors listed] [No authors listed] Lupus Sci Med. 2022 Feb;9(1):e000538corr1. doi: 10.1136/lupus-2021-000538corr1. Lupus Sci Med. 2022. PMID: 35135871 Free PMC article. No abstract available.

Abstract

Objective: To achieve consensus on a definition of remission in SLE (DORIS).

Background: Remission is the stated goal for both patient and caregiver, but consensus on a definition of remission has been lacking. Previously, an international task force consisting of patient representatives and medical specialists published a framework for such a definition, without reaching a final recommendation.

Methods: Several systematic literature reviews were performed and specific research questions examined in suitably chosen data sets. The findings were discussed, reformulated as recommendations and voted on.

Results: Based on data from the literature and several SLE-specific data sets, a set of recommendations was endorsed. Ultimately, the DORIS Task Force recommended a single definition of remission in SLE, based on clinical systemic lupus erythematosus disease activitiy index (SLEDAI)=0, Evaluator's Global Assessment <0.5 (0-3), prednisolone 5 mg/day or less, and stable antimalarials, immunosuppressives, and biologics.

Conclusion: The 2021 DORIS definition of remission in SLE is recommended for use in clinical care, education, and research including clinical trials and observational studies.

Keywords: healthcare; lupus erythematosus; outcome assessment; systemic; therapeutics.

PubMed Disclaimer

Conflict of interest statement

Competing interests: RFvV has received research and educational support (grants) from BMS, GSK, Lilly, Pfizer, Roche and UCB; and reimbursement for consultancy and/or speaking from AbbVie, AstraZeneca, Biogen, Biotest, BMS, Galapagos, Gilead, GSK, Janssen, Pfizer, Sanofi, Servier, UCB and Vielabio. RC—GSK, Alexion, Eli Lilly, AstraZeneca, Termo-Fisher and Rubió. BAP-E—GSK and Janssen. MFU-G received research grants from Janssen and Pfizer. LA acted as a consultant for Alexion, Amgen, AstraZeneca, BMS, GSK, Janssen-Cilag, LFB, Lilly, Menarini France, Medac, Novartis, Pfizer, Roche-Chugaï and UCB. CG—personal fees for honoraria from consultancy work from the Center for Disease Control, AstraZeneca, MGP, Sanofi and UCB; and personal fees for speaker’s bureau from UCB. HBo—unrestricted grants from Bristol-Myers Squibb and Roche; consultant for Bristol-Myers Squibb, Roche, Novartis, Medimmune and Union Chimique Belge; speaker for Bristol-Myers Squibb and Novartis; member of the advisory board of Bristol-Myers Squibb, Novartis and Sanofi. MI—consultations from GSK and Amgen. DJ—AstraZeneca, Aurinia, BMS, Boehringer-Ingelheim, Chemocentryx, Chugai, CSL, GSK, Infla-RX, Janssen, Novartis, Roche/Genentech, Takeda and Vifor. AK—honoraria from Bristol-Myers Squibb, KGaA, GlaxoSmithKline, Janssen Cilag and Lilly Deutschland. ML—receipts from GSK for advisory boards and sponsoring of investigator-initiated study. MN—research support from Actelion, AstraZeneca, BMS, GSK, Janssen and UCB; and honoraria from Actelion, Boehringer Ingelheim, Eli Lilly, GSK, Janssen, Pfizer and UCB. AT—consultation/speaker fees from UCB, GSK, Novartis and Janssen.

References

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2021 DORIS definition of remission in SLE: final recommendations from an international task force

Affiliations

2021 DORIS definition of remission in SLE: final recommendations from an international task force

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

References

Publication types

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LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical