In patients with systemic lupus erythematosus (SLE), achieving remission and a low disease activity status (LDAS) are important components in the overall prognosis of the disease, according to the results of the multiethnic, multinational Latin American Lupus Cohort (Grupo Latino Americano de Estudio del Lupus [GLADEL]) study, published in Annals of the Rheumatic Diseases.
Although it has been proposed that a treat-to-target strategy should be implemented in SLE, there is no consensus on the definitions of possible outcomes, nor has the impact of these possible outcomes been fully evaluated. The researchers therefore “aimed at determining the impact of remission and LDAS in [2 defined lupus outcomes:] damage and mortality.”
Disease activity, which was assessed 2 times per year, was ascertained via use of the SLE Disease Activity Index (SLEDAI). Each interval was categorized as 1 of the following 4 disease activity statuses: (1) remission off-therapy: SLEDAI=0 without prednisone or immunosuppressive (IS) therapy; (2) remission on-therapy: SLEDAI=0 and a prednisone ≤5 mg/day, and/or IS therapy (maintenance dose); (3) LDAS: SLEDAI ≤4, prednisone ≤7.5 mg/day, and/or IS therapy (maintenance dose); (4) nonoptimally controlled status: SLEDAI >4, and/or prednisone ≤7.5 mg/day, and/or IS therapy (induction dose). Antimalarial agents were permitted in all groups.
Predefined outcomes included mortality, new disease damage (increase of ≥1 Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index [SDI] point), and severe new damage (increase of ≥3 SDI points).
A total of 1350 patients were included in the study. Overall, 79 died during follow-up, 606 presented with new damage, and 177 presented with severe damage.
In multivariable analysis, remission (on/off treatment) was associated with a significantly lower risk for new damage (hazard ratio [HR] 0.60; 95% CI, 0.43-0.85; P =.0042) and for severe new damage (HR 0.32; 95% CI, 0.15-0.68; P =.0033). Moreover, LDAS was associated with a significantly lower risk for new damage compared with patients who had nonoptimal control of disease (HR 0.66; 95% CI, 0.48-0.93; P =.0158). No significant effect on mortality was reported in the study.
The investigators concluded that disease remission in patients with SLE is associated with a lower risk for new or severe new damage. Study findings also demonstrated that LDAS is linked to a lower risk for new damage after adjusting for other cofounders in this population.
Ugarte-Gil MF, Wojdyla D, Pons-Estel GJ, et al; on behalf of GLADEL. Remission and low disease activity status (LDAS) protect lupus patients from damage occurrence: data from a multiethnic, multinational Latin American Lupus Cohort (GLADEL) [published online September 22, 2017]. Ann Rheum Dis. doi:10.1136/annrheumdis-2017-211814.