Consensus Panel Defines Remission in SLE

An international consensus panel has provided a framework for testing individual definitions of remission in systemic lupus erythematosus (SLE) against longer-term outcomes.

There is no generally accepted definition for remission of SLE. An international expert panel of 60 rheumatologists, nephrologists, dermatologists, clinical immunologists, and patient representatives met to achieve consensus.

The consensus panel released its findings at the European League Against Rheumatism (EULAR) Annual Congress in Rome.

The panel expressed strong support for the following principles which will guide the further development of remission definitions:

• A definition of remission in SLE will be worded as follows: remission in SLE is a durable state characterized by a definition of absence of symptoms, signs, and abnormal labs (serology).
• Remission-off-therapy requires the patient to be on no other treatment for SLE than maintenance antimalarials.
• Remission-on-therapy allows patients to be treated with maintenance antimalarials, stable, low-dose steroids (prednisone less than 5 mg per day), maintenance immunosuppressives and/or stable (maintenance) biologics.
• Assessment of clinical symptoms and signs should be based on a validated index, and with labs included.

The most appropriate outcomes for remission are death, damage, flares, and health-related quality of life measures.

The panel also issued 8 key statements regarding remission in SLE:

• Remission is a desirable outcome for the patient with SLE.
• Remission in SLE includes, at the very least, the absence of major symptoms and signs of SLE.
• Remission in SLE is not the same as a cure.
• Remission in SLE is not the same as a low disease activity.
• Remission is a state that, if sustained, is associated with a low likelihood of adverse outcome.
• “Serologic activity” in SLE generally refers to the presence of anti-DNA antibodies and/or hypocomplementemia.
• Treatment with antimalarials does not preclude the patient from being considered to being in remission.
• Treatment with moderate- to high-dose steroids does not preclude the patient from being considered to being in remission.

References:

Van Vollenhoven RF, Aranow C, Bertias G, et al. Remission in SLE: consensus findings from a large international panel on definitions of remission in SLE (DORIS). EULAR 2015, Rome. Abstract OP0092