Lupus low disease activity state within 12 months is associated with favourable outcomes in severely active systemic lupus erythematosus. (7th January 2022)

• Record Type: Journal Article
• Authors: Kikuchi, Jun; Hanaoka, Hironari; Saito, Shuntaro; Oshige, Tatsuhiro; Hiramoto, Kazuoto; Kaneko, Yuko; Takeuchi, Tsutomu
• Is Part Of: Rheumatology. Volume 61:Number 9(2022)
• Page Start: 3777
• Page End: 3791
• Publication Date: 2022-01-07
• Subjects: systemic lupus erythematosus -- lupus low disease activity state -- low disease activity -- remission induction therapy -- outcome measure -- treatment target; Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/keac002
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: Objectives: To demonstrate the significance of the time to attain lupus low disease activity state (LLDAS) after remission induction therapy in patients with severely active SLE. Methods: We enrolled 79 patients starting prednisolone ≥0.4 mg/kg/day for active lupus with a BILAG 2004 index of A ≥ 1 or B ≥ 2, or for severe flare based on the Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SELENA-SLEDAI). The time to LLDAS attainment was divided into ≤6, 6–12 and >12 months and non-LLDAS; associations between the timing of LLDAS and flares, damage accrual and ≥50% LLDAS attainment were examined. Results: The mean SLEDAI was 17; median starting dose of prednisolone, 0.95 mg/kg/day; and mean observational period, 39.7 months. Six (7.6%) and 41 (51.9%) patients achieved LLDAS within 6 and 12 months. Patients with a shorter time to LLDAS achievement were more likely to spend ≥50% of the time in LLDAS and had a lower cumulative prednisolone dose; no differences were observed in damage accrual. Patients requiring longer than 12 months to achieve LLDAS had a higher prevalence of thrombocytopenia and those with non-LLDAS had lower renal function and a higher starting dose of prednisolone and steroid pulse therapy than those who achieved LLDAS within 12 months. Conclusion: Achieving LLDAS within 12 months of induction therapy may be favourable in patients with severely active SLE. The low frequency of LLDAS attainment in high-risk populations highlights the need for a new strategy for SLE treatment.