Prevalence, Determinants, and Outcomes of Low Disease Activity and Remission Attainment in Patients With Systemic Lupus Erythematosus That Is Clinically Active

Abstract

Objective: This study aimed to identify in patients with systemic lupus erythematosus (SLE) with clinically active disease the attainment of frequency and determinants of Lupus Low Disease Activity State (LLDAS) and Definition of Remission in SLE (DORIS) and the frequency and determinants of flare and damage accrual after target attainment. Methods: Patients in a multinational cohort with SLE who had clinical disease activity but were not in LLDAS or DORIS were observed prospectively. Results: A total of 1,991 patients (93.2% female) were observed for a median (interquartile range) of 2.5 (0.7–4.5) years, with 70.9% and 55.6% achieving LLDAS and DORIS, respectively. Nephritis and low complements were associated with a longer time, and antimalarial and immunosuppressant use were associated with a shorter time to LLDAS attainment. After the first LLDAS and DORIS attainment, 47.0% and 47.5% of the patients experienced flare(s), respectively, and 9.5% and 7.9 % of patients accrued organ damage within 24 months, respectively. Longer cumulative time at target and antimalarial use was associated with a longer time to flare and damage accrual, whereas dose reduction in glucocorticoids and immunosuppressants was associated with a shorter time to flare. Reduction in immunosuppressants also correlated with a shorter time to damage accrual. Conclusion: In patients with SLE with clinical disease activity, the proportion attaining LLDAS and DORIS under usual care conditions is suboptimal. Longer maintenance of these states is significantly associated with reduced risk of flare. Because flares and damage accrual still occur frequently following initial target attainment, further research is needed to inform strategies for maintaining these targets.