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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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11 2022
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Source: Ann Rheum Dis. 81(11):1541-1548
[PDF-122.36 KB]
Details:
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Alternative Title:Ann Rheum Dis
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Personal Author:
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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.
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Pubmed ID:35944946
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Pubmed Central ID:PMC10353886
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Volume:81
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Issue:11
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