Determinants and protective associations of the lupus low disease activity state in a prospective Chinese cohort

Abstract

Objective To investigate the frequency and determinants of achieving the lupus low disease activity state (LLDAS), and the effect of LLDAS attainment on disease flare and damage accrual in a prospective, single-center cohort of Chinese lupus patients. Methods Baseline and follow-up data from consecutive patients at the Peking University First Hospital were collected from January 2017 to June 2020. Results A total of 185 patients were enrolled, with median (range) disease duration at enrolment of 2.3 (0.8–7.7) years, and median follow-up of 2.2 (1.0–2.9) years. By the end of the study, 139 (75.1%) patients had achieved LLDAS at least once; 82 (44.3%) patients achieved LLDAS for ≥ 50% of observations. Multivariable logistic regression analysis showed that 24-h urinary total protein (UTP; per g) (OR = 0.447, 95%CI [0.207–0.968], p = 0.041), serum creatinine (Scr; per 10 µmol/L) (OR = 0.72, 95%CI [0.52–0.99], p = 0.040), and C3 level (per 100 mg/L) (OR = 1.60, 95%CI [1.18–2.17], p = 0.003) at recruitment had independent negative associations with achieving LLDAS for ≥ 50% of observations. Kaplan–Meier analyses showed a significant reduction in flare rate with increased proportion of time in LLDAS. Attainment of LLDAS in at least 50% of observations was an independent protective factor for damage accrual (OR = 0.19, 95%CI [0.04–0.99], p = 0.049). Conclusions In this prospective Chinese cohort, LLDAS was an attainable goal in clinical practice. Nephritis-related markers (UTP and Scr) and C3 level at recruitment negatively influenced achievement of LLDAS. LLDAS achievement was significantly protective from flare and damage accrual. Key points • Low disease activity status (LLDAS) is an achievable target during SLE treatment in China. Urine protein, serum creatinine, and C3 level at recruitment independently affect LLDAS achievement in this group of Chinese lupus patients. • As a treatment target, LLDAS achievement has a highly protective effect for preventing flare and damage accrual, especially in case of achieving LLDAS for ≥ 50% of observations. • The present results further highlight the practical significance of treat-to-target principle in SLE management (T2T/SLE) and the needs for promoting the application of T2T/SLE in clinical practice as well as exploring the concrete implement strategy.

Determinants of Low Disease Activity And Remission in Pediatric Systemic Lupus Erythematosus Patients

“…In the multivariate model of the same study, African American ethnicity, hypocomplementemia, serositis, kidney involvement, arthritis, anti-RNP, anti-dsDNA, vasculitis, malar rash, discoid rash, thrombocytopenia, and immunosuppressive use were found as negative predictors of LLDAS-50. Older age at the time of diagnosis, longer disease durations, higher education levels, and higher hydroxychloroquine intake rates were positive predictors of LLDAS-50 (17,18,19). Likewise, it has been shown that LLDAS is an achievable goal in clinical practice, but the achievement of LLDAS is more difficult among patients with discoid rashes, high anti-dsDNA levels, and hypocomplementemia (19).…”

“…Older age at the time of diagnosis, longer disease durations, higher education levels, and higher hydroxychloroquine intake rates were positive predictors of LLDAS-50 (17,18,19). Likewise, it has been shown that LLDAS is an achievable goal in clinical practice, but the achievement of LLDAS is more difficult among patients with discoid rashes, high anti-dsDNA levels, and hypocomplementemia (19). SLEDAI scores higher than 10 have…”

Outcomes of Patients Newly-diagnosed with Systemic Lupus Erythematosus Managed in a Tertiary Training and Referral Hospital in the Philippines

“…There were varying degrees of maintaining LLDAS: 29 (15.7%) patients were in LLDAS for 100% of observations, 53 (28.7%) for 50 to 100% of observations, and 58 (31.4%) in LLDAS for < 50% of observations. 21 Lastly, in a longitudinal collaborative study in nine countries in the Asia-Pacific region, 1846 patients were assessed and the criteria for LLDAS were met by 44%. There was low likelihood of LLDAS in patients with shorter disease duration (OR 0.31, 95 % CI 0.19-0.49), history of discoid rash (OR 0.66, 95 % CI 0.49-0.89), renal disease (OR 0.60, 95 % CI 0.48-0.75), elevated double stranded DNA (OR 0.65, 95 % CI 0.53-0.81) or low complement (OR 0.52, 95 % CI 0.40-0.67).…”

“…They found increasing proportion with organ damage within two years (37/104 or 35.6%) and three years (11/21, 52.4%). 21 A prospective study of a multiracial group of 350 patients in the UK since 1991 showed an incidence of damage accrual at two years postdiagnosis of 39.6/1000 patient-years, and incidence of serious organ damage (SDI score ≥3) of 10.4/1000 patient-years. 24 Furthermore, being able to maintain LLDAS was similarly associated with less organ damage accrual in a cohort of 293 Caucasians observed over seven years.…”

2022 Systemic lupus erythematosus remission in clinical practice. Message for Polish rheumatologists

“…Definitions of remission in SLE and LLDAS remission have been compared in the field of reducing flares and damage progression in various studies [ 29 , 30 ]. Based on these data, attempts were made to reach a definite conclusion that deeper and longer remission is associated with stronger protective effects against organ damage and its consequences.…”