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

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.

Performance of SLE responder index and lupus low disease activity state in real life: A prospective cohort study

“…Anti‐DNA antibodies, which may identify patients with more severe disease, were associated with a low likelihood of being in LLDAS, analyzing results both cross‐sectionally and longitudinally . Their role in predicting LLDAS failure might also reflect their being part of SLEDAI‐2K items.…”

“…35,36 Anti-DNA antibodies, which may identify patients with more severe disease, 37 were associated with a low likelihood of being in LLDAS, analyzing results both cross-sectionally and longitudinally. 10,12 Their role in predicting LLDAS failure might also reflect their being part of SLEDAI-2K items. Patients with a history of serositis who escalated their treatment at baseline achieved LLDAS more frequently after 12 months.…”

“…Specifically, a LLDAS is achieved when the patient's SLEDAI 2000 (SLEDAI‐2K) does not exceed a score of 4 (with no major organ active involvement) with a PGA score ≤ 1, a prednisone dose lower or equal to 7.5 mg in the absence of drug‐related toxicities or intolerance and of new clinical features compared to the previous evaluation. Increasing evidence suggests that LLDAS predicts the achievement of a low‐risk zone for early and late damage accrual . In addition, LLDAS has been shown to correlate with higher scores for quality of life assessment .…”

“…Increasing evidence suggests that LLDAS predicts the achievement of a low-risk zone for early and late damage accrual. 5,[11][12][13] In addition, LLDAS has been shown to correlate with higher scores for quality of life assessment. 14 Here, we aimed to prospectively assess the performance of SRI and LLDAS in a "real world" observational setting constituted by patients with long-standing disease and variable degrees of disease activity.…”

Frequency and predictors of the Lupus Low Disease Activity State in Chinese patients with systemic lupus erythematosus: a prospective observational cohort study

“…Among the definitions of low disease activity in SLE, the Lupus Low Disease Activity State (LLDAS) developed by Asia-Pacific Lupus Collaboration was well-validated and widely accepted [9][10][11][20][21][22]. Previous studies had proved that the maintenance of LLDAS during follow-up was associated with a lower frequency of organ damage accrual or flare [14][15][16][22][23][24][25]. Meanwhile, some studies had revealed the associated factors of maintaining LLDAS during follow-up [14,15,[22][23][24][25][26].…”