Achieving Remission or Low Disease Activity Reduces Damage Accrual in SLE

Achieving remission and low disease activity (LDA) levels results in reduced tissue damage accrual among patients with systemic lupus erythematosus (SLE), according to study findings published in Annals of the Rheumatic Diseases.

The aim of the study was to determine the impact of various definitions of SLE remission and LDA on damage accrual in patients with SLE who received 2 or more annual assessments.

Researchers conducted an international longitudinal study using data from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort. They analyzed 5 definitions of SLE remission and LDA levels.

• Remission off-treatment was defined as a clinical Systemic Lupus Erythematosus Disease Activity Index (cSLEDAI)-2K score of 0, without the use of prednisone or immunosuppressants.
• Remission on-treatment was defined as a cSLEDAI-2K score of 0, with the use of 5 mg or less of prednisone per day and/or use of maintenance immunosuppressants.
• The LDA, according to the Toronto cohort, was defined as achievement of cSLEDAI-2K score of 2 or lower, without prednisone or immunosuppressant use.
• The modified lupus LDA state (mLLDAS) was defined as a cSLEDAI-2K score of 4, with no activity in major organ systems, no new onset of disease activity, and use of maintenance immunosuppressants or 7.5 mg or less of prednisone per day.
• Active SLE disease state was defined as all other visits, ie, those patients who did not achieve the 4 definitions for remission or LDA levels.

Damage accrual was determined using the SLICC/American College of Rheumatology Damage Index (SDI).

A total of 1652 patients with SLE (88.6% women; mean age at diagnosis, 34.2 years), with a mean follow-up of 7.7 years, were included in the analysis.

The researchers observed that lower damage accrual correlated with remission off-treatment (incidence rate ratio [IRR], 0.75; 95% CI, 0.70-0.81), remission on-treatment (IRR, 0.68; 95% CI, 0.62-0.75), LDA Toronto cohort (IRR, 0.79; 95% CI, 0.68-0.92), and mLLDAS (IRR, 0.76; 95% CI, 0.65-0.89).

Study limitations included the inability to use the original definition of SLE remission due to lack of inclusion of the Physician Global Assessment (PGA); missing fluctuations in disease activity levels between scheduled visits; overrepresentation of damage occurring earlier vs later after disease onset; lack of gold standards for multiple test adjustments; and the inability to conclude whether more aggressive treatment or some underlying disease mechanisms contributed to achieving remission or LDA levels or if these factors decreased damage accrual.

“Remission on- and off-treatment, LDA [Toronto cohort] and mLLDAS were associated with less damage accrual, even adjusting for possible confounders and effect modifiers,” the study authors said. “This highlights the importance of treating-to-target in SLE.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.