Lupus & antiphospholipid syndrome
Association of sustained lupus low disease activity state with improved outcomes in systemic lupus erythematosus: a multinational prospective cohort study
Authors' conclusion
We observed significant protective associations of LLDAS and remission against damage accrual and flare, establish a threshold of 3 months sustained LLDAS or remission as protective, and demonstrate deepening protection with longer durations of sustained LLDAS or remission.
Study context
- Population
- Patients aged 18 years or older with systemic lupus erythematosus (SLE), 25 centres in 12 countries, followed up May 1, 2013, to Dec 31, 2020
- Participants
- 3,449 patients37,662 visits
- Exposure
- Sustained lupus low disease activity state (LLDAS) or remission vs not in that state
- Outcome
- Irreversible damage accrual (SLICC/ACR DI)
Methodological detailsmultinational, longitudinal, multicentre (25 centres in 12 countries), multi-failure time-to-event analyses, Median follow-up 2.8 years (IQR 1.1-5.6), 3180 (92.2%) women; 3031 (87.9%) Asian ethnicity
- Multinational
- Longitudinal
- Multicentre (25 centres in 12 countries)
- Multi-failure time-to-event analyses
- Median follow-up 2.8 years (IQR 1.1-5.6)
- 3180 (92.2%) women; 3031 (87.9%) Asian ethnicity
Main finding
As reported in the abstract
Damage accrual, any duration of sustained state >3 months
Hazard ratio (95% CI)P value
Sustained LLDAS
0.60(0.51–0.71)
P < 0.0001Sustained remission
0.66(0.57–0.76)
P < 0.0001Observational data: associations, not effects.
Secondary outcomes
Flare (SELENA Flare Index), key secondary outcome
| HR (95% CI) | P value | ||
|---|---|---|---|
| Sustained LLDAS | 0.56 (0.51–0.63) | P < 0.0001 | |
| Sustained remission | 0.66 (0.60–0.73) | P < 0.0001 | |
| 0.512Hazard ratio (log scale) |
- Attainment of sustained LLDAS at least once
- 72.7% · 2506 events
Attainment of sustained LLDAS at least once
- Sustained DORIS remission or steroid-free remission were less attainable than LLDAS
Original publication
Association of sustained lupus low disease activity state with improved outcomes in systemic lupus erythematosus: a multinational prospective cohort study. Lancet Rheumatol. Published 11 June 2024. doi:10.
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