BackgroundThe 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).MethodsLLDAS 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.ResultsThere 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).ConclusionLLDAS 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.
BackgroundIn the view of applying a treat to target (T2T) strategy in the management of systemic lupus erythematosus (SLE), a novel definition of minimal acceptable disease activity – the lupus low disease activity state (LLDAS) [1] – and clinical remission (CR) [2] were recently proposed.ObjectivesTo compare attainability and outcomes of LLDAS and CR as treatment targets in the early stages of SLE management.MethodsLLDAS and CR prevalence were analysed at 6 (T1) and 18 (T2) months after treatment initiation (T0) in a monocentric cohort of 107 (median disease duration 9.7 months) prospectively followed Caucasian SLE patients. LLDAS was defined as SLE disease activity index 2000 (SLEDAI-2K)≤4 without major organ activity and no new disease activity, physician global assessment (0–3)≤1, prednisone ≤7.5 mg/day and well-tolerated immunosuppressant dosages. CR was defined as clinical SLEDAI-2K=0 (increased anti-dsDNA and low complement were excluded) and prednisone ≤5 mg/day in patients treated with/without stable immunosuppressants and/or antimalarials. Multivariate models were built to identify factors associated with failure to achieve LLDAS and CR, as well as to investigate relationship between the latter and early damage accrual (defined as SLICC/Damage Index≥1 at T2).ResultsLLDAS was achieved significantly more frequently than CR both at T1 [47 (43.9%) vs. 25 (23.4%); p<0.001] and T2 [48 (44.9%) vs. 35 (32.7%); p<0.001]. Out patients achieving LLDAS, 25 (53.2%) and 35 (66.7%) concomitantly fulfilled the criteria for CR at T1 and T2, respectively. A prednisolone (PDN) dose exceeding the minimal acceptable range set in the respective definitions was the most frequent reason for failure to achieve both LLDAS and CR (in 83.0% of no-LLDAS patients at T1% and 95.1% of no-CR at T1). The disease manifestations with the highest persistence rate during follow-up were: increased anti-dsDNA (persistently present in 85.7% and 67.5% of cases at T1 and T2, respectively), low complement (73.2% and 66.3%) and renal abnormalities (46.4% and 28.6%). Renal involvement at baseline significantly associated with failure to achieve LLDAS both at T1 (OR: 7.8, 95% CI: 1.41–43.40; p=0.019) and T2 (OR: 3.87, 95% CI 1.41–10.6; p=0.008) and CR at T2 (OR 9.46, 95% CI 1.13–78.8). High PDN dosage was significantly associated with no-CR achievement both at T1 (OR 6.23, 95% CI 2.2–18.3; p=001) and T2 (OR 1.11, 95% CI 1.02–1.20; p=0.02). Early damage was recorded in 23 (21.5%) patients and was significantly associated, on multivariate analysis, with older age at diagnosis (OR 1.05 95% CI 1.01–1.09; p=0.016) and failure to achieve LLDAS (OR 4.82, 95% CI 1.44–16.09; p=0.11) at T1. No significant association was found between early damage and failure to achieve CR, possibly due to its low prevalence among this cohort of early SLE patients.ConclusionsDuring the early stages of SLE, LLDAS and CR overlap definitely less frequently than reported in long-standing disease (53.2%–66.7% vs 83.9%–96.5% [2]). Although remission is recommended as the primary tre...
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