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

Details

• Alternative Title:
  Ann Rheum Dis
• Personal Author:
  Ugarte-Gil, M. F. ; Hanly, J.G. ; Urowitz, M. B. ; Gordon, C. ; Bae, S. C. ; Romero-Diaz, J. ; Sanchez-Guerrero, J. ; Bernatsky, S. ; Clarke, A. E. ; Wallace, D. J. ; Isenberg, D. ; Rahman, A. ; Merrill, J. T. ; Fortin, P. R. ; Gladman, D. D. ; Bruce, I. N. ; Petri, M. A. ; Ginzler, E. M. ; Dooley, M. A. ; Ramsey-Goldman, R. ; Manzi, S. ; Jonsen, A. ; Van Vollenhoven, R. ; Aranow, C. ; Mackay, M. ; Ruiz-Irastorza, G. ; Lim, S. S. ; Inanc, M. ; Kalunian, K. C. ; Jacobsen, S. ; Peschken, C. ; Kamen, D. L. ; Askanase, A. D. ; Pons-Estel, B. ; Alarcón, G. S.
• Description:
  Objectives:
  
  To determine the independent impact of different definitions of remission and low disease activity (LDA) on damage accrual.
  
  Methods:
  
  Patients with ≥ two annual assessments from a longitudinal multinational inception lupus cohort were studied. Five mutually exclusive disease activity states were defined: Remission off-treatment: clinical (c) SLEDAI-2K=0, without prednisone or immunosuppressants; Remission on-treatment: cSLEDAI-2K=0, prednisone≤5mg/d and/or maintenance immunosuppressants; LDA-Toronto Cohort (TC): cSLEDAI-2K≤2, without prednisone or immunosuppressants; modified lupus LDA (mLLDAS): SLEDAI-2K≤4 with no activity in major organ/systems, no new disease activity, prednisone≤7.5mg/d 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 SLICC/ACR damage index (SDI). Univariable and multivariable generalized 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.
  
  Results:
  
  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) (95%CI)=0.75 (0.70–0.81); remission on-treatment IRR(95%)=0.68 (0.62–0.75) LDA: IRR (95%CI)=0.79 (0.68–0.92); mLLDAS IRR (95%)=0.76 (0.65–0.89)].
  
  Conclusions:
  
  Remission on- and off-treatment, LDA-TC and mLLDAS were associated with less damage accrual, even after adjusting for possible confounders and effect modifiers.
  
  
• Subjects:
  Antimalarials Disease Progression Female Humans Immunosuppressive Agents Lupus Erythematosus, Systemic Male Prednisone Remission Induction Severity Of Illness Index
• Keywords:
  Damage Low Disease Activity Low Lupus Disease Activity State Outcome Remission Systemic Lupus Erythematosus
• Source:
  Ann Rheum Dis. 81(11):1541-1548
• Pubmed ID:
  35944946
• Pubmed Central ID:
  PMC10353886
• Document Type:
  Journal Article
• Funding:
  M01 RR000046/RR/NCRR NIH HHSUnited States/ ; UL1 TR000150/TR/NCATS NIH HHSUnited States/ ; DH_/Department of HealthUnited Kingdom/ ; UL1 RR025741/RR/NCRR NIH HHSUnited States/ ; UL1 TR001422/TR/NCATS NIH HHSUnited States/ ; U01 DP005119/DP/NCCDPHP CDC HHSUnited States/ ; WT_/Wellcome TrustUnited Kingdom/ ; R01 AR069572/AR/NIAMS NIH HHSUnited States/ ; P60 AR064464/AR/NIAMS NIH HHSUnited States/ ; P60 AR048098/AR/NIAMS NIH HHSUnited States/ ; P30 AR072579/AR/NIAMS NIH HHSUnited States/ ; U01DP005119/ACL/ACL HHSUnited States/ ; R01 AR043727/AR/NIAMS NIH HHSUnited States/ ; ARC_/Arthritis Research UKUnited Kingdom/
• Volume:
  81
• Issue:
  11
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:2ba6383560b6d28e12fd156742c1acb1888d011381207bc997a76edae8bbf47893ea55ac59a6543ffc05f14f12b09e8b7ed6fe5542c57bf0527f206f95b7455a
• Download URL:
  https://stacks.cdc.gov/view/cdc/131055/cdc_131055_DS1.pdf
• File Type:
  [PDF - 122.36 KB ]