Association of Lupus Low Disease Activity State And Remission With Reduced Organ Damage And Flare in Systemic lupus erythematosus Patients With High Disease Activity

Kandane-Rathnayake R 1 , Golder V 1 , Louthrenoo W 2 , Chen YH 3 , Cho J 4 , Lateef A 5 Show all authors , Hamijoyo L 6 , Luo SF 7 , Wu YJ 7 , Navarra SV 8 , Zamora L 8 , Li Z 9 , Sockalingam S 10 , Katsumata Y 11 , Harigai M 11 , Hao Y 12 , Zhang Z 12 , Basnayake BMDB 13 , Chan M 14 , Kikuchi J 15 , Takeuchi T 15 , Bae SC 16 , Oon S 17 , O'Neill S 18 , Goldblatt F 19 , Ng KPL 20 , Law A 21 , Tugnet N 22 , Kumar S 23 , Tee C 24 , Tee M 24 , Ohkubo N 25 , Tanaka Y 25 , Lau CS 26 , Nikpour M 17 , Morand EF 1 , Hoi A 1

Affiliations 

  • 1 Department of Medicine, Sub-faculty of Clinical and Molecular Medicine, Monash University, Clayton, Victoria, Australia
  • 2 Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Thailand
  • 3 Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
  • 4 Rheumatology Division, University Medical Cluster, National University Hospital, Singapore
  • 5 Rheumatology Division, University Medical Cluster, National University Hospital, Singapore; Department of Medicine, Woodlands Health, Singapore
  • 6 Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
  • 7 Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taipei, Taiwan
  • 8 Rheumatology Center, University of Santo Tomas Hospital, Manila, Philippines
  • 9 Department of Rheumatology and Immunology, People's Hospital Peking University Health Sciences Centre, Beijing, China
  • 10 Department of Medicine, Faculty of Medicine Building, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 11 Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
  • 12 Rheumatology and Immunology department, Peking University First Hospital, Beijing, China
  • 13 Department of Nephrology, Teaching Hospital, Kandy, Sri Lanka
  • 14 Department of Rheumatology, Allergy & Immunology, Tan Tock Seng Hospital, Singapore
  • 15 Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
  • 16 Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
  • 17 Department of Rheumatology, St Vincent's Hospital, Melbourne Victoria, Australia
  • 18 Rheumatology department, Liverpool Hospital and the University of Sydney, New South Wales, Australia
  • 19 Department of Rheumatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
  • 20 Department of Rheumatology, Health New Zealand Waitemata, Te Whatu Ora (North Shore Hospital), Auckland, New Zealand
  • 21 Singapore General Hospital and Asia Arthritis and Rheumatology Centre, Singapore
  • 22 Health New Zealand Auckland, Te Whatu Ora (Greenlane Clinical Centre), Auckland, New Zealand
  • 23 Health New Zealand Counties Manukau, Te Whatu Ora (Middlemore Hospital), Auckland, New Zealand
  • 24 University of the Philippines, Manila, Philippines
  • 25 The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
  • 26 Division of Rheumatology & Clinical Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
Rheumatology (Oxford), 2024 Dec 04.
PMID: 39656834 DOI: 10.1093/rheumatology/keae631

Abstract

OBJECTIVE: High disease activity status (HDAS) in patients with systemic lupus erythematosus (SLE) is associated with adverse long-term outcomes. We examined the frequency of lupus low disease activity state (LLDAS) and remission (REM) attainment in HDAS patients and whether their attainment was associated with improved patient outcomes.

METHODS: Demographic, clinical and outcomes data, collected prospectively from a multinational cohort between 2013 and 2020, were analysed. Disease activity was assessed using SLEDAI-2K. HDAS was defined as SLEDAI-2K ≥ 10. Patients' first visit with SLEDAI-2K ≥ 10 was assigned as baseline. Survival analyses were performed to examine the associations between cumulative and sustained LLDAS and REM attainment in HDAS patients and subsequent organ damage accrual and flare.

RESULTS: 1,029 HDAS patients with a median study duration of 2.7 years [IQR: 1.0, 4.8] were studied. LLDAS and REM were attained at least once by 71% (LLDAS-ever, n = 726) and 41% (REM-ever, n = 418) of patients. Approximately one-fifth of patients attained ≥50% cumulative time in LLDAS or REM. 37% (n = 385) of patients attained ≥3months of sustained LLDAS, with progressively lower proportions of patients attaining longer periods of sustained LLDAS. Lower proportions of patients attained sustained REM. Attainment of cumulative and sustained LLDAS or REM provided significant protection against damage accrual and flare in HDAS patients. Sustained periods of LLDAS and REM were difficult to achieve and therefore a more stringent target, but provided the most protection against damage accrual or flare.

CONCLUSION: LLDAS and REM were achievable targets in HDAS patients, and provided significant protection against adverse outcomes.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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