Time to Lupus Low Disease Activity State in the Hopkins Lupus Cohort: Role of African American Ethnicity

Abstract

Objective. Lupus low disease activity state (LLDAS) is a potential treat-to-target goal in systemic lupus erythematosus (SLE). This study determined predictors of time to reach LLDAS in a longitudinal cohort.Methods. Patients were grouped according to LLDAS status at cohort entry. Those who did not satisfy LLDAS at cohort entry were analyzed prospectively. The Kaplan-Meier approach was used to estimate the time to LLDAS. Cox regression was used to identify patient characteristics that were associated with time to LLDAS.Results. The probability of LLDAS attainment within 1 year was 52% for Caucasians, 36% for African Americans, and 33% for SLE patients with renal involvement. The median time to LLDAS was 1.1 years. In multivariable models, African American ethnicity, baseline prednisone >10 mg daily, hypocomplementemia, baseline damage, and baseline renal activity remained significant predictors of longer time to attain LLDAS, while disease duration <1 year and cutaneous activity were associated with earlier attainment.Conclusion. LLDAS is potentially attainable in the majority of SLE patients. The time to LLDAS was found to be longer in African American patients with SLE. Characteristics of African American patients with SLE, such as renal activity and hypocomplementemia, were also independent predictors of slower attainment of LLDAS. These findings point to the need to include African American patients with SLE in both clinical and pharmaceutical research.

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

“…Babaoglu et al found that patients with disease duration ≤1 year had shorter time to LLDAS [26]. Our study confirmed the association and further found that treatment-naïve was also a positive predictor of LLDAS achievement.…”

“…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.…”

“…In our SLE cohort, the time to LLDAS was 1.7 years, which was longer than that in the Johns Hopkins Lupus Cohort (1.1 years) mainly consisting of Caucasian and African-American patients [26]. The difference may be partly due to the different disease activity at baseline.…”

“…Cohort study consisting of Caucasian and African-American SLE patients [26]. 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].…”

“…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.…”