Failure to Achieve Low Disease Activity Linked to Early Damage Accrual in SLE

Lupus low disease activity state (LLDAS), a promising treatment target among white patients in the early stages of systemic lupus erythematosus (SLE), has been shown to be achievable and negatively associated with early damage accrual, according to the results of a prospective Italian cohort study published in Arthritis Research & Therapy.

Researchers evaluated the prevalence of LLDAS at 6 months (T1) and 18 months (T2) after diagnosis and treatment initiation (T0) in a monocentric cohort of 107 white patients with SLE. Median disease duration was 9.7 months. Reasons for failure to achieve LLDAS were examined. The relationship between LLDAS and Systemic Lupus International Collaboration Clinics Damage Index accrual was also explored.

Overall, 43.9% (47 of 107) of patients were in LLDAS at T1, and 44.9% (48 of 107) of patients were in LLDAS at T2. The most common unmet LLDAS criterion was prednisolone dose >75 mg/day (83% of patients with no LLDAS at T1). Disease manifestations with the lowest rates of remission at T1 and T2 follow-up included increased anti-double-stranded DNA (persistently reported in 85.7% and 67.5% of participants, respectively), low serum complement fractions (73.2% and 66.3%, respectively), and renal abnormalities (46.4% and 28.6%, respectively).

Renal involvement at T0 was significantly associated with failure to attain LLDAS both at T1 (odds ratio [OR], 7.8; 95% CI, 1.4-43.4; P =.019) and at T2 (OR, 3.9; 95% CI, 1.4-10.6; P =.008). The occurrence of any organ damage (Systemic Lupus International Collaboration Clinics Damage Index ≥1) at T2 was significantly associated with absence of LLDAS at T1 (OR, 5.0; 95% CI, 1.5-16.6; P =.009) and older age at diagnosis (OR, 1.05; 95% CI, 1.01-1.09; P =.020).

The investigators concluded that LLDAS is a potential treatment target in patients with SLE, which is both attainable and negatively associated with damage accrual in early stages of the disease. LLDAS appears to fit poorly with the heterogeneity of clinical presentation in patients with SLE, however, particularly in those with renal involvement.

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Reference

Piga M, Floris A, Cappellazzo G, et al. Failure to achieve lupus low disease activity state (LLDAS) six months after diagnosis is associated with early damage accrual in Caucasian patients with systemic lupus erythematosus. Arthritis Res Ther. 2017;19(1):247.