medwireNews: Each of four commonly defined targets for remission or low disease activity (LDA) are independently associated with a reduced risk for damage accrual, relative to active disease, in people with systemic lupus erythematosus (SLE), research suggests.
Writing in the Annals of the Rheumatic Diseases, Manuel Ugarte-Gil (Universidad Científica del Sur, Lima, Peru) and co-authors say: “It would be expected that remission, in particular remission off-treatment, was associated with a lower probability of damage accrual.”
However, they add that according to their data, LLDAS and the Toronto Cohort LDA (LDA-TC) criteria could also “be good targets in SLE management.”
The study included data for 1652 participants (mean age 34.2 years at diagnosis, 88.6% women) of the multinational Systemic Lupus International Collaborating Clinics (SLICC) cohort.
During a mean 7.7 years of follow-up, the participants attended a total of 12,236 physician visits.
At 20.9% of these visits, participants were classified as in remission off-treatment, defined as a clinical SLEDAI-2K score of 0 without prednisone or immunosuppressants, and at 19.8% of visits they were considered to be in remission on-treatment, defined as a clinical SLEDAI-2K score of 0, with prednisone treatment at or below 5 mg/day and/or maintenance immunosuppressants.
At a further 4.5% of visits, participants were classed as LDA-TC, with a clinical SLEDAI-2K score of 2 or lower, without prednisone or immunosuppressants, with another 5.6% having a modified (m)LLDAS, defined as a SLEDAI-2K score of 4 or lower with no activity in major organs or systems, no new disease activity, prednisone use at or below 7.5 mg/day, and/or taking maintenance immunosuppressants. At the remaining 49.2% of visits, patients had active disease.
The researchers note that if more than one criterion was met per visit, the most stringent definition was used.
Throughout the follow-up period, 46.1% of participants had an increase of 1 or more points on the SLICC/American College of Rheumatology Damage Index (SDI), indicating damage accrual.
The team found that being in remission off-treatment was associated with a significant 25% lower probability of damage accrual per 25% increase in time spent in that state relative to having active disease, after adjustment for sociodemographic and disease- and treatment-related variables.
The same increases in time spent in remission on-treatment, LDA-TC, and mLLDAS were associated with significant 32%, 21%, and 24%, lower rates of damage accrual, respectively, compared with active disease.
More specifically, Ugarte-Gil et al report that remission off-treatment, remission on-treatment, and LDA-TC were each independently associated with a lower risk for ophthalmologic and renal damage.
In addition, remission off-treatment and on-treatment were both associated with lower rates of neuropsychiatric, cardiovascular, musculoskeletal, and skin damage, while there were lower risks for lung and gonadal damage during remission off-treatment, and for peripheral vascular damage with LDA-TC, and a lower probability of diabetes when participants achieved mLLDAS.
The researchers comment that they do not currently “know how achievement of remission or LLDAS mediates decreased damage accrual” and whether it is associated with more mild underlying disease, more aggressive therapy, or other factors.
Nonetheless, they conclude that their “data are relevant to propose treat-to-target strategies and to define outcomes for clinical trials.”
They add: “The high rate of remission should encourage the use of remission on-treatment or off-treatment as our ideal target, with LDA (LDA-TC and LLDAS) being only an alternative target.”
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Ann Rheum Dis 2022; doi:10.1136/ard-2022-222487