Predictors of predominant Lupus Low Disease Activity State (LLDAS-50)

Abstract

Aim The Lupus Low Disease Activity State (LLDAS) is a potential treat to target goal in systemic lupus erythematosus (SLE). SLE patients in LLDAS for more than half of the observation time have about a 50% lower risk of new organ damage and have reduced mortality. We identified predictors of being in LLDAS ≥50% of the observation time. Methods A total of 2228 SLE patients who had at least three clinical visits were included. Percentage of time in LLDAS was calculated based on the proportion of days under observation. LLDAS-50 was defined as being in LLDAS for ≥50% of the observation time. We used the stepwise selection procedure in logistic regression to identify predictors of LLDAS-50. Results A total of 1169 (52.5%) SLE patients, but only 37.6% of African Americans, achieved LLDAS-50. In the multivariable model, African American ethnicity, hypocomplementemia, serositis, renal activity, arthritis, anti-RNP, anti-dsDNA, vasculitis, malar rash, discoid rash, thrombocytopenia, and immunosuppressive use were negative predictors of LLDAS-50. Older age at diagnosis, longer disease duration, higher education level, and greater percentage of time taking hydroxychloroquine remained positive predictors of LLDAS-50. Conclusion In this large cohort, only 52.5% achieved LLDAS-50. This proportion was even less in African Americans. A higher percentage of time taking hydroxychloroquine was a modifiable positive predictor of LLDAS-50. Anti-RNP, anti-dsDNA, and low complement were negatively associated with LLDAS-50. Our findings further emphasize the importance of inclusion of African Americans in clinical trials and hydroxychloroquine adherence in both clinical practice and clinical trials.

Cognitive dysfunction among people with systemic lupus erythematosus is associated with reduced participation in daily life

“…These results dovetail with qualitative work in which people with SLE report pain and fatigue as among the most frequent or problematic aspects of the disease and describe their negative impact on social, leisure and family participation. 32,33 Interestingly, other common manifestations of SLE that have been found to affect activities of daily living and health-related quality of life, such as depressive symptoms, anxiety and sleep problems, 14 were not independently related to participation in our sample. These factors are known to be related to cognition, fatigue, and pain and to each other in SLE, 33 so it is possible that their contributions to participation were masked.…”

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

“…The probability of patients achieving these states seems to vary according to a number of factors including race/ethnicity, in particular African ancestry, 8 9 age at diagnosis, 10 previous disease activity, 8 10 11 major organ involvement 10 12 and treatment. [8][9][10] Furthermore, the clinical impact of achieving such states in several clinical outcomes has been examined. 13 The outcome most frequently evaluated has been organ damage accrual; in fact, in several cohorts, remission and/or LDA have been found to prevent damage, but the exact definitions used for these states have not been uniform.…”

Long-term outcomes in systemic lupus erythematosus: trends over time and major contributors

“…Several studies have shown that the risk of damage decreases with the length of time in either LLDAS or remission. While low disease activity intuitively appears to be a less desirable outcome than remission, patients in the LLDAS nevertheless achieve significantly better scores on both the SLE Quality of Life questionnaire and the 36-item Short Form Health Survey [ 76 ], reduced direct healthcare costs [ 77 ], damage and mortality than those with active disease [ 78 ]. Importantly, patients who spent even a short time in clinical remission (even <25% of visits) had a significant decrease in the rate of damage compared with never achieving remission.…”