Impact of remission and low disease activity on health-related quality of life in patients with systemic lupus erythematosus

Abstract

Objectives To investigate the impact of remission and lupus low disease activity state (LLDAS) on health-related quality of life (HRQoL) in systemic lupus erythematosus. Methods SF-36, EQ-5D-3L and FACIT-Fatigue data from the BLISS-52 (NCT00424476) and BLISS-76 (NCT00410384) trials were used. Duration in remission/LLDAS required to reach a HRQoL benefit ≥ minimal clinically important differences (MCIDs) during and post-treatment was determined using quantile regression and generalised estimating equations. Results Patients (N = 1684) were assessed every 4th week (15 visits). Four cumulative (β = 0.60) or four consecutive (β = 0.66) visits in remission were required to achieve a benefit ≥MCID in SF-36 physical component summary (PCS) scores, and six cumulative (β = 0.44) or five consecutive (β = 0.49) for a benefit ≥MCID in mental component summary (MCS) scores. Eight cumulative (β = 0.30 for both) or eight consecutive (β = 0.32 for both) visits in LLDAS were required for a benefit in PCS/MCS ≥MCID, respectively. For EQ-5D-3L index scores ≥MCID, six cumulative (β = 0.007) or five consecutive (β = 0.008) visits in remission were required, and eight cumulative (β = 0.005) or six consecutive (β = 0.006) visits in LLDAS. For FACIT-Fatigue scores ≥MCID, 12 cumulative (β = 0.34) or 10 consecutive (β = 0.39) visits in remission were required, and 17 cumulative (β = 0.24) or 16 consecutive (β = 0.25) visits in LLDAS. Conclusion Remission and LLDAS contribute to a HRQoL benefit in a time-dependent manner. Shorter time in remission than in LLDAS was required for a clinically important benefit in HRQoL, and longer time in remission for a benefit in mental compared with physical HRQoL aspects. When remission/LLDAS was sustained, the same benefit was achieved in a shorter time.

Low disease activity state associated with fewer incident vertebral fractures in Mestizo women with systemic lupus erythematosus

“…Our study provides a body of evidence addressed to exploring the influence of LDAS on different outcomes. Prior evidence of LDAS in SLE has evaluated the associations between LDAS and a reduced risk of flares, 29,30 damage accrual, [6][7][8][9][10][31][32][33] adverse outcomes in pregnancy, 34 better HRQOL, [35][36][37] progression of subclinical atherosclerosis, 38 and reduced mortality. 7 Although several studies have analyzed the association between LDAS and damage accrual in SLE, as previously mentioned, only a few, to our knowledge, have made scarce reference to osteoporotic fractures.…”

“…Our study provides a body of evidence addressed to exploring the influence of LDAS on different outcomes. Prior evidence of LDAS in SLE has evaluated the associations between LDAS and a reduced risk of flares, 29,30 damage accrual, 6–10,31–33 adverse outcomes in pregnancy, 34 better HRQOL, 35–37 progression of subclinical atherosclerosis, 38 and reduced mortality. 7…”

Seasonal vitamin D levels and lupus low disease activity state in systemic lupus erythematosus

“…Setting LLDAS achievement as a treatment goal in SLE enhances quality of life and decreases damage accrual and survival 31 . This approach leads to an increase in patient satisfaction 32,33 . Therefore, increasing evidence from recent SLE research and clinical practice supports LLDAS as a treatment target for the management of SLE 34…”

“…31 This approach leads to an increase in patient satisfaction. 32,33 Therefore, increasing evidence from recent SLE research and clinical practice supports LLDAS as a treatment target for the management of SLE. 34 Taking these trends into consideration, we conducted an analysis of the relationship between LLDAS and vitamin D. The results obtained were novel and have not been previously reported.…”

EQ-5D full health state after therapy heralds reduced hazard to accrue subsequent organ damage in systemic lupus erythematosus

“…In the wake of this trend, the principle of treat-to-target has evolved during the past decade as a strategy for the management of rheumatic diseases e.g., rheumatoid arthritis (RA) ( 32 ). In later years, it has also been successfully applied in SLE, where remission ( 33 , 34 ) and Lupus Low Disease Activity State (LLDAS) ( 35 , 36 ) have been demonstrated to associate with deceleration of organ damage accrual ( 37 ) and favourable HRQoL experience ( 38 , 39 ), and hence receive increasing endorsement as treatment targets ( 31 ). However, in contrast to the Disease Activity Score (DAS)-28-based definition of remission used in RA ( 40 ), which encompasses patient-reported global health, common definitions of remission and low disease activity in SLE do not include patient-reported components.…”