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

Abstract

Objective To prospectively assess the performance of the systemic lupus erythematosus (SLE) responder index (SRI) and the lupus low disease activity state (LLDAS) in a cohort‐based, “real‐life” clinical setting. Methods One hundred and thirty‐one consecutive patients with SLE were subdivided into two groups based on the need or not to escalate their immune suppressive treatment. Clinimetrics including physician global assessment scale (PGA), SLE Disease Activity Index 2000 (SLEDAI‐2K), European Consensus Lupus Activity Measurement index (ECLAM) and British Isles Lupus Assessment Group index (BILAG) 2004 version were measured at baseline and at 6 and 12 months, together with laboratory data and treatment changes. LLDAS and SRI were calculated at each time point. Results Lupus low disease activity state but not SRI‐4 correlated with treatment de‐escalation. Low disease activity attainment as estimated by LLDAS was more frequent in patients starting with lower SLEDAI‐2K, whereas a decrease in SLEDAI score ≥ 4 points with < 0.3 increased PGA and no new grade A or more than one new grade B BILAG domains (SRI‐4) was more frequent in patients with higher SLEDAI‐2K and/or severe renal activity at baseline. Anti‐DNA‐positive patients were less likely to be in LLDAS at any time point. Serositis was associated with lack of LLDAS at baseline, but did not affect LLDAS achievement at 12 months. Normalizing complement levels heralded the achievement of LLDAS and SRI‐4. Conclusion Lupus low disease activity state is a valuable tool for assessing response to treatment in the daily rheumatology practice. SRI might be less informative, at least in patients with low basal SLEDAI.

Long-Term Clinical Outcome in Systemic Lupus Erythematosus Patients Followed for More Than 20 Years: The Milan Systemic Lupus Erythematosus Consortium (SMiLE) Cohort

“…Consistent with previous studies, we observed that the achievement of a stable remission might protect from late flares and eventually damage [15,17,28,32,33]. Notably, we also confirmed that LLDAS largely overlaps with clinical remission [15] and might constitute a feasible treatment endpoint both in clinical trials and routine rheumatology practice [26,34,35]. In line with other reports, we also found that the musculoskeletal system was most frequently involved in late flares and more prone to be involved in damage accrual [27,29].…”

Impact of the COVID-19 pandemic in patients with systemic lupus erythematosus throughout one year

“…Despite this, only 17% of patients felt that the pandemic had a detrimental impact on their disease. Indeed, the reported annual rate of patients needing treatment escalation at least once was 29%, which is stable compared to the pre-pandemic setting [ 40 ]. The all-cause annual hospitalisation rate in this study was 9.6/100 person-years, which is also consistent with our preliminary observations during the first pandemic wave [ 21 ] and previous evidence in the literature from non-pandemic settings [ 41 ].…”

Histone‐Specific CD4+ T Cell Plasticity in Active and Quiescent Systemic Lupus Erythematosus

“…23 Regarding patients with SLE, clinical, laboratory, and treatment features at time of enrollment were collected through a dedicated in-house software as previously described. 24 Disease activity was measured by using the SLE Disease Activity Index 2000 (SLEDAI-2K). 25 The Lupus Low Disease Activity State (LLDAS) was used as a surrogate of remission.…”