Frequency and predictors of the lupus low disease activity state in a multi-national and multi-ethnic cohort

Abstract

BackgroundSystemic lupus erythematosus (SLE) is a chronic heterogeneous disease with considerable burden from disease activity and damage. A novel clinical treatment target in the form of the lupus low disease activity state (LLDAS) has been recently reported, with retrospective validation showing that time spent in LLDAS translates to reduced damage accrual. The objectives of this study were to describe the frequency and identify the predictors of attaining LLDAS in a large multinational cohort of patients with SLE.MethodsData were collected at the recruitment visit in patients with SLE enrolled in a longitudinal study in nine countries. Data were analysed cross-sectionally against the recently published definition of LLDAS, and the frequency and characteristics associated with presence of LLDAS were determined. Stepwise multivariable logistic regression was used to determine predictors of LLDAS.ResultsOf the 1846 patients assessed, criteria for LLDAS were met by 44 %. Patients with shorter disease duration were less likely to be in LLDAS (OR 0.31, 95 % CI 0.19–0.49, p < 0.001). Likewise, patients with a history of discoid rash (OR 0.66, 95 % CI 0.49–0.89, p = 0.006), renal disease (OR 0.60, 95 % CI 0.48–0.75, p < 0.001), elevated double stranded DNA (OR 0.65, 95 % CI 0.53–0.81, p < 0.001) or hypocomplementaemia (OR 0.52, 95 % CI 0.40–0.67, p < 0.001) were less likely to be in LLDAS. When countries were compared, higher national social wealth (OR 1.57, 95 % CI 1.25–1.98, p < 0.001) as measured by the gross domestic product per capita was positively associated with LLDAS, but ethnicity was not.ConclusionThe lupus low disease activity state is observed in less than half of patients with SLE at a single point in time. Disease duration and phenotype, and national social wealth, are predictive of LLDAS.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-016-1163-2) contains supplementary material, which is available to authorized users.

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

“…In line with data from other European cohorts, more than half of our patients were in LLDAS at any time point. This percentage was higher than the one reported by Golder and co‐workers, who analyzed a large cohort of patients with SLE with a broad spectrum of disease durations . As highlighted by data from inception cohorts and from studies in early‐onset populations, SLE tends to be more aggressive during the first years from onset and in patients of younger age, possibly causing accelerated damage accrual .…”

“…Anti‐DNA antibodies, which may identify patients with more severe disease, were associated with a low likelihood of being in LLDAS, analyzing results both cross‐sectionally and longitudinally . Their role in predicting LLDAS failure might also reflect their being part of SLEDAI‐2K items.…”

“…The lupus low disease activity state (LLDAS) has been originally validated in a cohort‐based setting. It focuses on the achievement of fixed conditions rather than variations from baseline . Specifically, a LLDAS is achieved when the patient's SLEDAI 2000 (SLEDAI‐2K) does not exceed a score of 4 (with no major organ active involvement) with a PGA score ≤ 1, a prednisone dose lower or equal to 7.5 mg in the absence of drug‐related toxicities or intolerance and of new clinical features compared to the previous evaluation.…”

Systemic lupus erythematosus: an update

“…The concept of lupus low disease activity state (LLDAS) has been shown to be an achievable target, and is associated with less damage accrual 40 . A large multinational prospective cohort study is underway to validate the significance of LLDAS, and to determine its predictors 41 . Future studies on treatment strategy may involve newer agents, but better still, may reveal ways that we can use existing therapies more optimally.…”

“…40 A large multinational prospective cohort study is underway to validate the significance of LLDAS, and to determine its predictors. 41 Future studies on treatment strategy may involve newer agents, but better still, may reveal ways that we can use existing therapies more optimally. One possibility is to consider selected use of therapeutic drug monitoring for the commonly used drugs in SLE to improve their efficacy and safety.…”