Expert Opinion Correlates With Lupus Low Disease Activity State Definition

Analysis of expert opinion compared with the current definition of lupus low disease activity state (LLDAS) reveals a fair correlation, implying that LLDAS is valid as a treat-to-target goal, according to findings published in Rheumatology.

Researchers conducted a cross-sectional analysis using baseline data from an ongoing multicenter, longitudinal study of patients with systemic lupus erythematosus (SLE) in Spain. The study comprised 508 individuals (92% women; mean age 50.4±13.7 years). Data collected at baseline included gender, date of SLE diagnosis, date of birth, SLE criteria and clinical variables, a subjective disease evaluation by a rheumatologist, and treatment data. The LLDAS criteria was applied to determine agreement between it and the physician’s opinion.

Among the study patients, 62.7% (n=304) met all 5 criteria for LLDAS, while physician opinion resulted in a figure of 86.1% (n=430) for low activity or remission (overall agreement 71.4% [95% CI, 70.1-70.5]; Cohen kappa 0.3 [95% CI, 0.22-0.37]).

Among the LLDAS-defined cases, 96.1% were classified as such by experts. Physicians classified 70.4% (n=126 out of 179) as low activity or remission in patients with SLE who did not fulfill the LLDAS criteria. New manifestations compared with previous visits accounted for most discrepancies, as did a Safety of Estrogens in SLE National Assessment (SELENA)-SLE Disease Activity Index (SLEDAI-2K) score of greater than 4.

The main limitation of this study is the cross-sectional design of the initial visit.

The study authors conclude, “[W]e found that LLDAS is a feasible target in the…strategy of management of SLE patients.” They also note, “The overall agreement between LLDAS and the physician’s expert opinion about SLE activity is fair, although improves considerably in patients that achieve LLDAS.”

Reference

Altabás-González I, Rúa-Figueroa I, Rubiño F, et al. Does expert opinion match the definition of lupus low disease activity state? prospective analysis of 500 patients. Rheumatol. Published online August 12, 2022. doi:10.1093/rheumatology/keac462