Residual disease activity and treatment intensification in systemic lupus erythematosus: A cross-sectional study to quantify the need for new therapies. (December 2022)

• Record Type: Journal Article
• Authors: Gioti, Ourania; Chavatza, Katerina; Nikoloudaki, Myrto; Katechis, Spyridon; Bertsias, George; Boumpas, Dimitrios T; Fanouriakis, Antonis
• Is Part Of: Lupus. Volume 31:Number 14(2022)
• Page Start: 1726
• Page End: 1734
• Publication Date: 2022-12
• Subjects: systemic lupus erythematosus -- disease activity -- treatment intensification; Systemic lupus erythematosus -- Periodicals; 616.772005
• DOI: 10.1177/09612033221129776
• Languages: English
• ISSNs: 0961-2033

Abstract

Objective: The proportion of SLE patients with residual disease activity in routine settings is variable. We assessed disease activity state in patients during their most recent visit, and whether patients with residual activity were offered therapy intensification. Methods: Cross-sectional study of consecutive lupus patients in three tertiary centers. Patients were categorized as: i) remission off-therapy, ii) remission on-therapy, iii) low disease activity, and iv) non-optimally controlled disease. Multivariable regression identified factors associated with treatment intensification and ROC analysis calculated the accuracy of SLEDAI-2K to predict this intensification. Results: Three hundred and thirty-two patients were included [93.1% female, mean (SD) age 48.5 (14.7) years, median (IQR) disease duration 6.5 (12.4) years]. Mean (SD) total and clinical SLEDAI at last visit were 3.7 (3.0) and 3.0 (2.9), respectively. Although 23.2% of patients were in remission, 40.1% were categorized as non-optimally controlled disease (79.2% due to SLEDAI-2K > 4), but less than 50% of them were offered therapy intensification. Proteinuria (OR 6.78, 95% CI 2.06–22.25), arthritis (OR 5.48, 95% CI 3.20–9.40), and rash (OR 3.23, 95% CI 1.81–5.75) were associated with intensification of therapy, but the accuracy of either total or clinical SLEDAI to predict it was moderate (ROC area under the curve 0.761 and 0.779, respectively). Conclusions: About 40% of patients have evidence of residual disease activity and could qualify for novel treatments. Most treatment changes were triggered by active renal, joint, and skin disease, whereas the predictive value of SLEDAI-2K as a metric of disease activity was modest.