Predictors of predominant Lupus Low Disease Activity State (LLDAS-50). (December 2019)

• Record Type: Journal Article
• Authors: Babaoglu, H; Li, J; Goldman, D; Magder, L S; Petri, M
• Is Part Of: Lupus. Volume 28:Number 14(2019)
• Page Start: 1648
• Page End: 1655
• Publication Date: 2019-12
• Subjects: Ethnicity -- hydroxychloroquine -- LLDAS -- low disease activity state -- systemic lupus erythematosus; Systemic lupus erythematosus -- Periodicals; 616.772005
• DOI: 10.1177/0961203319886028
• Languages: English
• ISSNs: 0961-2033

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.