Remission and low disease activity (LDA) prevent damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort.
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Author
Ugarte-Gil, Manuel FranciscoHanly, John
Urowitz, Murray
Gordon, Caroline
Bae, Sang-Cheol
Romero-Diaz, Juanita
Sanchez-Guerrero, Jorge
Bernatsky, Sasha
Clarke, Ann Elaine
Wallace, Daniel J
Isenberg, David Alan
Rahman, Anisur
Merrill, Joan T
Fortin, Paul R
Gladman, Dafna D
Bruce, Ian N
Petri, Michelle
Ginzler, Ellen M
Dooley, Mary Anne
Ramsey-Goldman, Rosalind
Manzi, Susan
Jönsen, Andreas
van Vollenhoven, Ronald F
Aranow, Cynthia
Mackay, Meggan
Ruiz-Irastorza, Guillermo
Lim, Sam
Inanc, Murat
Kalunian, Ken
Jacobsen, Søren
Peschken, Christine
Kamen, Diane L
Askanase, Anca
Pons-Estel, Bernardo A
Alarcón, Graciela S
Journal title
Annals of the rheumatic diseasesDate Published
2022-08-09Publication Volume
81Publication Issue
11Publication Begin page
1541Publication End page
1548
Metadata
Show full item recordAbstract
To determine the independent impact of different definitions of remission and low disease activity (LDA) on damage accrual.Patients with ≥2 annual assessments from a longitudinal multinational inception lupus cohort were studied. Five mutually exclusive disease activity states were defined: remission off-treatment: clinical Systemic Lupus Erythematosus Disease Activity Index (cSLEDAI)-2K=0, without prednisone or immunosuppressants; remission on-treatment: cSLEDAI-2K score=0, prednisone ≤5 mg/day and/or maintenance immunosuppressants; low disease activity Toronto cohort (LDA-TC): cSLEDAI-2K score of ≤2, without prednisone or immunosuppressants; modified lupus low disease activity (mLLDAS): Systemic Lupus Erythematosus Disease Activity Index-2K score of 4 with no activity in major organ/systems, no new disease activity, prednisone ≤7.5 mg/day and/or maintenance immunosuppressants; active: all remaining visits. Only the most stringent definition was used per visit. Antimalarials were allowed in all. The proportion of time that patients were in a specific state at each visit since cohort entry was determined. Damage accrual was ascertained with the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). Univariable and multivariable generalised estimated equation negative binomial regression models were used. Time-dependent covariates were determined at the same annual visit as the disease activity state but the SDI at the subsequent visit.
There were 1652 patients, 1464 (88.6%) female, mean age at diagnosis 34.2 (SD 13.4) years and mean follow-up time of 7.7 (SD 4.8) years. Being in remission off-treatment, remission on-treatment, LDA-TC and mLLDAS (per 25% increase) were each associated with a lower probability of damage accrual (remission off-treatment: incidence rate ratio (IRR)=0.75, 95% CI 0.70 to 0.81; remission on-treatment: IRR=0.68, 95% CI 0.62 to 0.75; LDA: IRR=0.79, 95% CI 0.68 to 0.92; and mLLDAS: IRR=0.76, 95% CI 0.65 to 0.89)).
Remission on-treatment and off-treatment, LDA-TC and mLLDAS were associated with less damage accrual, even adjusting for possible confounders and effect modifiers.
Citation
Ugarte-Gil MF, Hanly J, Urowitz M, Gordon C, Bae SC, Romero-Diaz J, Sanchez-Guerrero J, Bernatsky S, Clarke AE, Wallace DJ, Isenberg DA, Rahman A, Merrill JT, Fortin PR, Gladman DD, Bruce IN, Petri M, Ginzler EM, Dooley MA, Ramsey-Goldman R, Manzi S, Jönsen A, van Vollenhoven RF, Aranow C, Mackay M, Ruiz-Irastorza G, Lim S, Inanc M, Kalunian K, Jacobsen S, Peschken C, Kamen DL, Askanase A, Pons-Estel BA, Alarcón GS. Remission and low disease activity (LDA) prevent damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort. Ann Rheum Dis. 2022 Nov;81(11):1541-1548. doi: 10.1136/ard-2022-222487. Epub 2022 Aug 9. PMID: 35944946.DOI
10.1136/ard-2022-222487ae974a485f413a2113503eed53cd6c53
10.1136/ard-2022-222487
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Except where otherwise noted, this item's license is described as © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.
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