Usefulness of the lupus low disease activity state as a treatment target in childhood-onset SLE
Authors' conclusion
Patients with LN and pre-existing damage are at higher risk of increased future damage acquisition, even if achieving a T2T state such as LLDAS. Among proposed common T2T states, the LLDAS is the hardest to achieve and maintain.
Study context
- Population
- Childhood-onset SLE patients in the Cincinnati Lupus Registry, followed up until 18 years of age (lupus nephritis (LN): 45, white: 95)LN: 45
- Participants
- 165 patients
- Exposure
- Treat-to-target states compared: SLEDAI-LD vs low-CS vs lupus low disease activity state (LLDAS)
- Outcome
- Achievement of T2T states during follow-up (median 4 years)
Methodological detailsregistry-based (Cincinnati Lupus Registry)
- Registry-based (Cincinnati Lupus Registry)
Main finding
As reported in the abstract
- Patients with LN significantly less likely to achieve any treat-to-target (T2T) state
- all p<0.03
- Patients with LN required significantly longer time to reach T2T states
- all p<0.0001
Observational data: associations, not effects.
Further findings
New damage despite reaching T2T state
Median
| Outcome | SLEDAI-LD | Low-CS | LLDAS |
|---|---|---|---|
| Proportion of follow-up time T2T state maintained | 86% (IQR 55%–100%) | 76% (IQR 48%–100%) | 39% (IQR 13%–64%) |
- New damage despite reaching T2T state — Higher risk of new damage with LN vs without LN despite achieving low-CS
- p=0.009
- New damage despite reaching T2T state — Higher risk of new damage with LN vs without LN despite achieving LLDAS
- p=0.04
Predictors of failure to maintain LLDAS
- LN
- P ≤ 0.0062
- Pre-existing damage
- P ≤ 0.0271
- Non-white race
- P ≤ 0.0013
Original publication
Usefulness of the lupus low disease activity state as a treatment target in childhood-onset SLE. Lupus Sci Med. Published 30 May 2023. doi:10.
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