Chanakya Sharma1, Warren Raymond2, Gro Eilertsen3, Johannes Nossent4. 1. Sir Charles Gairdner Hospital, Perth, Australia. 2. School of Medicine, University of Western Australia, Crawley, Australia. 3. Arctic University, Tromsø, Norway. 4. Sir Charles Gairdner Hospital, Perth, Australia and School of Medicine, University of Western Australia, Crawley, Australia.
Abstract
OBJECTIVE: To assess the impact of achieving Lupus Low Disease Activity State ≥50% of the time (LLDAS-50) on damage accrual and mortality in an inception cohort of patients with systemic lupus erythematosus (SLE). METHODS: We used data from the Tromsø Lupus Cohort, a longitudinal population-based study of all patients with SLE in the 2 northernmost counties in Norway. LLDAS was defined as 1) a Systemic Lupus Erythematosus Disease Activity Index 2000 score of ≤4, with no activity in major organ systems, 2) no new features of lupus disease activity, 3) current therapy with prednisolone (or equivalent) dosage of ≤7.5 mg daily, and 4) well-tolerated standard maintenance dosages of immunosuppressive drugs. RESULTS: A total of 69 patients (33.5%) spent at least half of their follow-up time in LLDAS (thus, achieving LLDAS-50) and had significantly better survival and lower risk of developing severe damage over time, according to the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index. After correcting for age and sex, LLDAS-50 was associated with a significant reduction in risk of having severe damage (hazard ratio [HR] 0.37 [95% confidence interval (95% CI) 0.19-0.73], P < 0.01), and also a reduction in mortality (HR 0.31 [95% CI 0.16-0.62], P < 0.01). CONCLUSION: Our study validates the findings of the inception cohort by demonstrating that achievement of LLDAS-50 is associated with a significant reduction in severe damage and, for the first time, demonstrates a reduction in mortality.
OBJECTIVE: To assess the impact of achieving Lupus Low Disease Activity State ≥50% of the time (LLDAS-50) on damage accrual and mortality in an inception cohort of patients with systemic lupus erythematosus (SLE). METHODS: We used data from the Tromsø Lupus Cohort, a longitudinal population-based study of all patients with SLE in the 2 northernmost counties in Norway. LLDAS was defined as 1) a Systemic Lupus Erythematosus Disease Activity Index 2000 score of ≤4, with no activity in major organ systems, 2) no new features of lupus disease activity, 3) current therapy with prednisolone (or equivalent) dosage of ≤7.5 mg daily, and 4) well-tolerated standard maintenance dosages of immunosuppressive drugs. RESULTS: A total of 69 patients (33.5%) spent at least half of their follow-up time in LLDAS (thus, achieving LLDAS-50) and had significantly better survival and lower risk of developing severe damage over time, according to the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index. After correcting for age and sex, LLDAS-50 was associated with a significant reduction in risk of having severe damage (hazard ratio [HR] 0.37 [95% confidence interval (95% CI) 0.19-0.73], P < 0.01), and also a reduction in mortality (HR 0.31 [95% CI 0.16-0.62], P < 0.01). CONCLUSION: Our study validates the findings of the inception cohort by demonstrating that achievement of LLDAS-50 is associated with a significant reduction in severe damage and, for the first time, demonstrates a reduction in mortality.
Authors: Manuel Francisco Ugarte-Gil; Anselm Mak; Joanna Leong; Bhushan Dharmadhikari; Nien Yee Kow; Cristina Reátegui-Sokolova; Claudia Elera-Fitzcarrald; Cinthia Aranow; Laurent Arnaud; Anca D Askanase; Sang-Cheol Bae; Sasha Bernatsky; Ian N Bruce; Jill Buyon; Nathalie Costedoat-Chalumeau; Mary Ann Dooley; Paul R Fortin; Ellen M Ginzler; Dafna D Gladman; John Hanly; Murat Inanc; David Isenberg; Soren Jacobsen; Judith A James; Andreas Jönsen; Kenneth Kalunian; Diane L Kamen; Sung Sam Lim; Eric Morand; Marta Mosca; Christine Peschken; Bernardo A Pons-Estel; Anisur Rahman; Rosalind Ramsey-Goldman; John Reynolds; Juanita Romero-Diaz; Guillermo Ruiz-Irastorza; Jorge Sánchez-Guerrero; Elisabet Svenungsson; Murray Urowitz; Evelyne Vinet; Ronald F van Vollenhoven; Alexandre Voskuyl; Daniel J Wallace; Michelle A Petri; Susan Manzi; Ann Elaine Clarke; Mike Cheung; Vernon Farewell; Graciela S Alarcon Journal: Lupus Sci Med Date: 2021-12