Lupus Low Disease Activity State Predicts SLE Outcomes

A consensus definition of a lupus low disease activity state appears to predict improved outcomes among patients with systemic lupus erythematosus (SLE), according to a new study. A definition of a low disease activity state in systemic lupus erythematosus would, as in rheumatoid arthritis, enable clinicians to develop treat-to-target strategies. A panel of lupus experts from the Far East and Australia used Delphi and nominal group techniques to define, and then validate, a lupus low disease activity state.[[{"type":"media","view_mode":"media_crop","fid":"42490","attributes":{"alt":"©KozakDmytro/Shutterstock","class":"media-image media-image-right","id":"media_crop_6321346652694","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4609","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":" ","typeof":"foaf:Image"}}]] The five-part definition of lupus low disease activity state includes: 

1. SLE Disease Activity Index (SLEDAI)-2K of 4 or less, with no activity in major organ systems (renal, central nervous system, cardiopulmonary, vasculitis, fever) and no hemolytic anemia or gastrointestinal activity.

2. No new lupus disease activity compared with the previous assessment.

3. A Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA)-SLEDAI physician global assessment of 1 or less.

4. A current prednisolone (or equivalent) dose of 7.5 mg or less daily.

5. Well-tolerated standard maintenance doses of immunosuppressive drugs and approved biological agents.

After devising the definition, the researchers validated it by looking retrospectively at the frequency of lupus low disease activity state in 191 patients, average age 33.3 years at diagnosis. The patients had average 7.3 years disease duration and were all antinuclear antibody positive. Two-thirds of them demonstrated anti-dsDNA positivity. They were predominantly of European (58.1%) and Asian (39.5%) descent. The mean SLEDAI-2K at recruitment was 5.1, with nearly 80% of patients having musculoskeletal manifestations; just more than 50% had evidence of lupus nephritis prior to or during the study. The researchers followed the patients for an average of 3.9 years. Patients who spent greater than 50% of their observed time in lupus low disease activity state had significantly reduced organ damage accrual and were significantly less likely to have an increase in Systemic Lupus International Collaborating Clinics Damage Index of 1 or more compared with patients who spent less than 50% of their time in lupus low disease activity state. Those who spent more time in a lupus low disease activity state had significantly lower prednisolone dose during follow-up, but also used significantly fewer immunosuppressant drugs; had significantly less disease activity; had significantly less frequent multiple specific manifestations of SLE; and had a statistically significantly lower hazard of any future flare or severe flare. The researchers concluded that “the results of our analyses are highly encouraging for the validity and potential usefulness of the current definition” of lupus low disease activity state. They noted that the consensus definition did not include a patient reported outcome or quality of life measure because there is not enough evidence yet to support concordance with disease activity. 

Disclosures:

Kate Franklyn K, Lau CS, et al.

"Definition and initial validation of a Lupus Low Disease Activity State (LLDAS),"

Ann Rheum Dis

doi:10.1136/annrheumdis-2015-207726