Achieving remission or low disease activity is associated with better outcomes in patients with systemic lupus erythematosus: a systematic literature review

Abstract

BackgroundRemission and low disease activity (LDA) have been proposed as the treatment goals for patients with systemic lupus erythematosus (SLE). Several definitions for each have been proposed in the literature.ObjectiveTo assess the impact of remission/LDA according to various definitions on relevant outcomes in patients with SLE.MethodsThis systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses using PubMed (1946–week 2, April 2021), Cochrane library (1985–week 2, week 2, April 2021) and EMBASE (1974–week 2, April 2021). We included longitudinal and cross-sectional studies in patients with SLE reporting the impact of remission and LDA (regardless their definition) on mortality, damage accrual, flares, health-related quality of life and other outcomes (cardiovascular risk, hospitalisation and direct costs). The quality of evidence was evaluated using the Newcastle-Ottawa Scale.ResultsWe identified 7497 articles; of them, 31 studies met the inclusion criteria and were evaluated. Some articles reported a positive association with survival, although this was not confirmed in all of them. Organ damage accrual was the most frequently reported outcome, and remission and LDA were reported as protective of this outcome (risk measures varying from 0.04 to 0.95 depending on the definition). Similarly, both states were associated with a lower probability of SLE flares, hospitalisations and a better health-related quality of life, in particular the physical domain.ConclusionRemission and LDA are associated with improvement in multiple outcomes in patients with SLE, thus reinforcing their relevance in clinical practice.PROSPERO registration numberCRD42020162724.

LLDAS (lupus low disease activity state) and/or remission are associated with less damage accrual in patients with systemic lupus erythematosus from a primarily Mestizo population: data from the Almenara Lupus Cohort

“…In this primarily Mestizo prevalent lupus cohort, remission and LLDAS were associated with less damage accrual, independent of other well-known risk factors for this endpoint; this is consistent with other reports 5 6 9 10…”

Remission and low disease activity (LDA) prevent damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort

“…Rates of remission and LDA vary around the world, with remission being most frequent in European populations (almost 90% for at least 1 year in the Padova cohort)25 but less frequent in Latin American (20% achieved remission at least once during the follow-up) 6. As the SLICC cohort is a multinational, multiethnic cohort, the proportion of patients in remission on and off-treatment is consistent with the literature 2. However, the relatively low proportion of visits in LDA-TC and mLLDAS but not in remission suggests that a better gradation of response state between remission and active is needed.…”

“…According to these data, remission could be an achievable state in many patients, and it should remain as the ideal target in SLE treatment. However, as more stringent definitions (remission off-treatment and on-treatment) are less frequently achieved in patients with a higher risk of poorer outcomes (like non-white populations or with more severe manifestations), less stringent definitions could be more realistic outcomes for the treatment of SLE patients 2 41–43. For example, European Alliance of Associations for Rheumatology (EULAR) and Pan American League of Associations of Rheumatology (PANLAR) guidelines recommended remission or LDA as the therapeutic goal 44 45…”

“…Remission and low disease activity (LDA) have been proposed as targets for the management of systemic lupus erythematosus (SLE) 1. These states have been associated with a lower probability of mortality, damage, flares, hospitalisation, costs and cardiovascular events and with a better health-related quality of life 2. However, there are various definitions of these states.…”

Systemic lupus erythematosus: history and modernity

“…В соответствии с концепцией «лечение до достижения цели» (Treat-to-Target) [43,44], в основе ведения пациентов с СКВ лежит разработка индивидуальных (пациенто-ориентированных -patient-centered) программ терапии [45,46], направленных на достижение ремиссии (или низкой активности) [47,48] как основы для предотвращения необратимого повреждения внутренних органов и улучшения отдаленного прогноза. Это нашло отражение в разработке обновленных рекомендаций по ведению пациентов с СКВ [49][50][51] и антифосфолипидного синдрома [52].…”