Lupus low disease activity state as a treatment endpoint for systemic lupus erythematosus: a prospective validation study

Golder, Vera; Kandane‐Rathnayake, Rangi; Huq, Molla; Nim, Hieu T.; Louthrenoo, Worawit; Luo, Shue Fen; Wu, Yeong‐Jian Jan; Lateef, Aisha; Sockalingam, Sargunan; Navarra, Sandra V.; Zamora, Leonid; Hamijoyo, Laniyati; Katsumata, Yasuhiro; Harigai, Masayoshi; Chan, Madelynn; O’Neill, Sean; Goldblatt, Fiona; Lau, Chak Sing; Li, Zhan Guo; Hoi, Alberta; Nikpour, Mandana; Morand, Eric F

doi:10.1016/s2665-9913(19)30037-2

Cited by 77 publications

(56 citation statements)

References 27 publications

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“…Some previous studies found that patients with LLDAS ≥50% of follow-up time had a lower level of SLEDAI at baseline [14,22,23], and other studies found that baseline SLEDAI ≤4 was a predictor of achieving LLDAS and maintaining LLDAS for 5 years [15,26]. The present study showed that patients with lower disease activity (by PGA or SLEDAI-2K) at baseline were more quickly to achieve LLDAS.…”

supporting

confidence: 60%

“…Several studies found that Asians had significant differences with Caucasians in terms of disease activity, renal involvement, autoantibody-positive rate, organ damage rate and mortality rate [27][28][29][30][31][32]. Moreover, studies by Asia-Pacific Lupus Collaboration showed that the possibility of LLDAS ≥ 50% time during follow-up was lower in Asian population than that in Caucasians, though it did not reach statistical difference [22,23]. No data about the attainability of LLDAS achievement in Asian ethnicity has been reported so far.…”

Section: Until Now the Only One Study Which Estimated The Attainabilmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

“…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]. However, most of these studies included the patients who had already achieved LLDAS at baseline, therefore, they were unable to analyse the attainability of LLDAS achievement from high or moderate disease activity to LLDAS.…”

Section: Introductionmentioning

confidence: 99%

“…Previous researches had demonstrated that patients with juvenile-onset SLE had higher disease activity, received more intensive prednisone and IMs therapy, had more organ damage and a two-fold higher mortality rate, compared with adult-onset patients [38][39][40][41][42]. Recently, some studies reported that patients who were in LLDAS ≥50% time or observations during follow-up had older age at diagnosis of SLE [14,22,23]. In the present study, patients with older age at disease onset were demonstrated to have shorter time to LLDAS after adjusting other factors, including daily prednisone dose, SLEDAI and PGA.…”

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confidence: 99%

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

Gao

Hao

et al. 2019

Preprint

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supporting

confidence: 60%

Section: Until Now the Only One Study Which Estimated The Attainabilmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Gao

Hao

et al. 2019

Preprint

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Patterns of Medication Use in Systemic Lupus Erythematosus: A Multicenter Cohort Study

Kandane‐Rathnayake

Louthrenoo

Luo

et al. 2022

Arthritis Care & Research

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for the Asia-Pacific Lupus Collaboration Objective. Evidence for the utility of medications in settings lacking randomized trial data can come from studies of treatment persistence. The present study was undertaken to examine patterns of medication use in systemic lupus erythematosus (SLE) using data from a large multicenter longitudinal cohort.Methods. Prospectively collected data from the Asia Pacific Lupus Collaboration cohort including disease activity (SLE Disease Activity Index 2000 [SLEDAI-2K]) and medication details, captured at every visit from 2013-2018, were used. Medications were categorized as glucocorticoids (GCs), antimalarials (AM), and immunosuppressants (IS). Cox regression analyses were performed to determine the time-to-discontinuation of medications, stratified by SLE disease activity.Results. Data from 19,804 visits of 2,860 patients were analyzed. Eight medication categories were observed: no treatment; GC, AM, or IS only; GC plus AM; GC plus IS; AM plus IS; and GC plus AM plus IS (triple therapy). Triple therapy was the most frequent pattern (31.4% of visits); single agents were used in 21% of visits, and biologics in only 3%. Time-to-discontinuation analysis indicated that medication persistence varied widely, with the highest treatment persistence for AM and lowest for IS. Patients with a time-adjusted mean SLEDAI-2K score of ≥10 had lower discontinuation of GCs and higher discontinuation of IS.Conclusion. Most patients received combination treatment. GC persistence was high, while IS persistence was low. Patients with high disease activity received more medication combinations but had reduced IS persistence, consistent with limited utility. These data confirm unmet need for improved SLE treatments.

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Predictors of Organ Damage in Systemic Lupus Erythematosus in the Asia Pacific Region: A Systematic Review

Ramnarain,

Liam,

Milea

et al. 2024

Arthritis Care & Research

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ObjectivesIrreversible organ damage is common in patients with systemic lupus erythematosus (SLE). Despite evidence of increased prevalence and severity of SLE in Asia Pacific, organ damage is less well studied in this region. This systematic review aims to identify predictors of organ damage in SLE in the Asia Pacific region.MethodsWe searched Medline, PubMed, Embase and Web of Science for observational studies on organ damage in adult SLE patients in Asia Pacific from August 31st ‐ September 5th 2022. Study selection and data extraction was completed by two independent reviewers using Covidence systematic review software. Risk of bias was assessed using the Newcastle‐Ottawa Scale and Joanna‐Briggs Institute tool. Significant results from univariable and multivariable analyses were synthesized from included studies.ResultsThirty‐eight eligible studies were selected from 1999 – 2022; 22 (58%) of these reported organ damage at study enrolment and 19 (50%) reported damage accrual, as measured by the Systemic Lupus International Collaborating Clinic/American College of Rheumatology Damage Index. Factors predictive of organ damage included older age, glucocorticoid use, longer disease duration and disease activity. Lupus nephritis was a risk factor for renal and overall damage accrual. Hydroxychloroquine was protective against overall organ damage.ConclusionPredictors of organ damage in SLE in Asia Pacific are similar to other regions. Whilst glucocorticoid use is a modifiable risk factor for organ damage, the impact of immunosuppressives and biological therapies needs further investigation. Effective strategies in early disease are needed to minimise initial organ damage as it predicts subsequent damage accrual.

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Lupus low disease activity state as a treatment endpoint for systemic lupus erythematosus: a prospective validation study

Cited by 77 publications

References 27 publications

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

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

Patterns of Medication Use in Systemic Lupus Erythematosus: A Multicenter Cohort Study

Predictors of Organ Damage in Systemic Lupus Erythematosus in the Asia Pacific Region: A Systematic Review

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