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Multicenter Study
. 2025 May 1;64(5):2741-2748.
doi: 10.1093/rheumatology/keae631.

Association of lupus low disease activity state and remission with reduced organ damage and flare in systemic lupus erythematosus patients with high disease activity: a multi-national, longitudinal cohort study

Rangi Kandane-Rathnayake  1 , Vera Golder  1   2 , Worawit Louthrenoo  3 , Yi-Hsing Chen  4 , Jiacai Cho  5 , Aisha Lateef  5   6 , Laniyati Hamijoyo  7 , Shue-Fen Luo  8 , Yeong-Jian J Wu  8 , Sandra V Navarra  9 , Leonid Zamora  9 , Zhanguo Li  10 , Sargunan Sockalingam  11 , Yasuhiro Katsumata  12 , Masayoshi Harigai  12 , Yanjie Hao  13   14 , Zhuoli Zhang  13 , B M D B Basnayake  15 , Madelynn Chan  16 , Jun Kikuchi  17 , Tsutomu Takeuchi  17   18 , Sang-Cheol Bae  19   20 , Sheeran Oon  14 , Sean O'Neill  21 , Fiona Goldblatt  22 , Kristine Pek Ling Ng  23 , Annie Law  24 , Nicola Tugnet  25 , Sunil Kumar  26 , Cherica Tee  27 , Michael Tee  27 , Naoaki Ohkubo  28 , Yoshiya Tanaka  28 , Chak Sing Lau  29 , Mandana Nikpour  14   30 , Eric F Morand  1   2 , Alberta Hoi  1   2
Affiliations
Multicenter Study

Association of lupus low disease activity state and remission with reduced organ damage and flare in systemic lupus erythematosus patients with high disease activity: a multi-national, longitudinal cohort study

Rangi Kandane-Rathnayake et al. Rheumatology (Oxford). .

Abstract

Objective: High disease activity status (HDAS) in patients with systemic lupus erythematosus (SLE) is associated with adverse long-term outcomes. We examined the frequency of lupus low disease activity state (LLDAS) and remission (REM) attainment in HDAS patients and whether their attainment was associated with improved patient outcomes.

Methods: Demographic, clinical and outcomes data, collected prospectively from a multinational cohort between 2013 and 2020, were analysed. Disease activity was assessed using SLEDAI-2K. HDAS was defined as SLEDAI-2K ≥ 10. Patients' first visit with SLEDAI-2K ≥ 10 was assigned as baseline. Survival analyses were performed to examine the associations between cumulative and sustained LLDAS and REM attainment in HDAS patients and subsequent organ damage accrual and flare.

Results: A total of 1029 HDAS patients with a median study duration of 2.7 years [IQR: 1.0, 4.8] were studied. LLDAS and REM were attained at least once by 71% (LLDAS-ever, n = 726) and 41% (REM-ever, n = 418) of patients. Approximately one-fifth of patients attained ≥50% cumulative time in LLDAS or REM. In total, 37% (n = 385) of patients attained ≥3months of sustained LLDAS, with progressively lower proportions of patients attaining longer periods of sustained LLDAS. Lower proportions of patients attained sustained REM. Attainment of cumulative and sustained LLDAS or REM provided significant protection against damage accrual and flare in HDAS patients. Sustained periods of LLDAS and REM were difficult to achieve and were therefore a more stringent target, but provided the most protection against damage accrual or flare.

Conclusion: LLDAS and REM were achievable targets in HDAS patients, and provided significant protection against adverse outcomes.

Keywords: high disease activity; lupus low disease activity state; outcomes; systemic lupus erythematosus.

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Figures

Figure 1.
Figure 1.
Kaplan–Meier survival estimates of organ damage accrual (A and C) and flare (B and D) in patients spending ≥365 days in sustained (dark green) vs cumulative LLDAS (light green) (A and B), and in patients spending ≥365 days in sustained (dark blue) vs cumulative remission (REM) (light blue) (C and D)
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