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

Abstract

ObjectiveTo determine if achieving lupus low disease activity state (LLDAS) or remission prevents damage accrual in a primarily Mestizo population.MethodsPatients with SLE from a single-centre cohort with at least two visits occurring every 6 months were included. The definitions used were the following: for remission, the 2021 Definition Of Remission In SLE; and for LLDAS, the Asia Pacific Lupus Collaboration. Damage accrual was ascertained with the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). Univariable and three multivariable interval-censored survival regression models were done: (1) remission versus not on remission; (2) LLDAS/remission versus active; and (3) remission and LLDAS (not on remission) versus active. Three similar multivariable models were also examined considering the duration on each state. Possible confounders included in these analyses were gender, age at diagnosis, socioeconomic status, educational level, disease duration, antimalarial use and SDI at baseline.ResultsTwo hundred and eighty-one patients were included. Eighty-three patients (29.5%) showed increased SDI during the follow-up. In the analyses of remission, being on remission predicted a lower probability of damage (HR=0.456; 95% CI 0.256 to 0.826; p=0.010). In the analyses of LLDAS/remission, being on LLDAS/remission predicted a lower damage (HR=0.503; 95% CI 0.260 to 0.975; p=0.042). When both states were considered, remission but not LLDAS (not on remission) predicted a lower probability of damage (HR=0.423; 95% CI 0.212 to 0.846; p=0.015 and HR=0.878; 95% CI 0.369 to 2.087; p=0.768, respectively). When the duration of these states was taken into account, remission, LLDAS/remission and LLDAS not on remission were associated with a lower probability of damage accrual.ConclusionsLLDAS and/or remission were associated with a lower probability of damage accrual.

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

“…Our results are consistent with those from other cohorts; for example, in the GLADEL, Almenara and the Cagliari cohorts, LLDAS (excluding those in remission off-treatment and on-treatment) was associated with lower damage,6 13 26 while in the Padova cohort,21 those in remission accrued less damage than those in LLDAS; however, in the Toronto cohort,4 those in LDA-TC (and not in remission) and those in remission accrued damage similarly.…”

“…However, these results should be interpretated carefully as they have overlapping CIs. Additionally, these results suggest that the longer the patient remains in remission or an LDA state, the better the outcome, in line with observations from several other cohorts 9 11 17 21 26. According to these data, remission could be an achievable state in many patients, and it should remain as the ideal target in SLE treatment.…”

Low disease activity state associated with fewer incident vertebral fractures in Mestizo women with systemic lupus erythematosus

“…Our study provides a body of evidence addressed to exploring the influence of LDAS on different outcomes. Prior evidence of LDAS in SLE has evaluated the associations between LDAS and a reduced risk of flares, 29,30 damage accrual, 6–10,31–33 adverse outcomes in pregnancy, 34 better HRQOL, 35–37 progression of subclinical atherosclerosis, 38 and reduced mortality. 7…”

“…This frequency is similar to that identified in another cohort of SLE analyzing Mestizo populations from Peru, in which the percentages of LDAS were 68.4% and remission 54.6%. 10 In that study, which had a larger sample size than our cohort, the authors applied the complete definition for LDAS, including PGA criteria. In other SLE cohorts, including Hispanic persons (from the United States and Latin America), 26,45 employing similar definitions to those we applied for LDAS, LDAS from both cohorts were lower than that reported by our work group.…”

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.…”