Prevalence, determinants and outcomes of low disease activity and remission attainment in SLE patients with clinically active disease

Abstract

Objectives: This study aimed to identify the frequency and determinants of Lupus Low Disease Activity State (LLDAS) and Definition of Remission in SLE (DORIS-remission) attainment in systemic lupus erythematosus (SLE) patients with clinically active disease, and the frequency and determinants of flare and damage accrual after target attainment.

Methods: Patients in a multi-national SLE cohort who had clinical disease activity but were not in LLDAS or DORIS-remission were followed prospectively.

Results: 1991 patients (93.2% female) were followed for a median (IQR) of 2.5 (0.7-4.5) years, with 70.9% and 55.6% achieving LLDAS and DORIS-remission, respectively. Nephritis and low complements were associated with a longer time, and antimalarial and immunosuppressant use were associated with a shorter time to LLDAS attainment. After the first LLDAS and DORIS-remission attainment, 47.0% and 47.5% of the patients experienced flare(s), respectively, and 9.5% and 7.9 % of patients accrued organ damage within 24 months, respectively. Longer cumulative time at target and antimalarial use was associated with a longer time to flare and damage accrual, while dose reduction in glucocorticoids and immunosuppressants was associated with a shorter time to flare. Reduction in immunosuppressants also correlated with a shorter time to damage accrual.

Conclusions: In SLE patients with clinical disease activity, the proportion attaining LLDAS and DORIS-remission under usual care conditions is suboptimal. Longer maintenance of these states is significantly associated with reduced risk of flare. As flares and damage accrual still occur frequently following initial target attainment, further research is needed to inform strategies for maintaining these targets.