Background We aimed to evaluate the effect of Systemic Lupus Erythematosus Disease Activity Score (SLE-DAS) and Definition Of Remission In SLE (DORIS) remission state on damage accrual in SLE.
Methods We defined SLE patients from Lupus Clinic of Royal Thai Army (LUCRA) cohort based on Index and Boolean-based SLE-DAS and DORIS for remission state. Those who were not in any remission definitions were defined as non-remission status. Sustained remission was defined as those with prolonged remission state for ≥ 1 year. Regression analysis models were constructed to identify predictors of the Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) during follow up.
Results There were 198 patients identified: 98 patients met at least 1 definition of sustain remission state and 100 patients in non-remission group. Of 98 patients, 97 patients were achieved Index-based definitions, 75 patients achieved Boolean-based definition, and 55 patients were achieved Doria definition. The mean ± SD of follow up was 4.77 ± 0.6 years. The changes in SDI over time were non-significant lower in patient who met any definition of remission compared with those who not. Multivariable analysis revealed that predictive factors of increased SDI were age (HR 1.03, p = 0.01) and baseline SDI ≥ 1 (HR 2.54, p = 0.01). However, Index, Boolean, and Doria-based definition of remission had no significant relative risk reduction on SDI compared with non-remission group (HR 0.7, p= 0.27; HR 0.73, p =0.37; HR 0.8, p= 0.55, respectively).
Conclusions To achieve sustained remission state based on definitions of SLE-DAS and DORIS showed relative protective effect on damage accrual compared to non-remission status, but not statistically significant. These definitions had a comparable effect and could be used as the treatment goal of treat to target strategies in SLE.
Jesus D, Matos A, Henriques C, Zen M, Larosa M, Iaccarino L, Da Silva JAP, Doria A, Inês LS. Derivation and validation of the SLE Disease Activity Score (SLE-DAS): a new SLE continuous measure with high sensitivity for changes in disease activity. Ann Rheum Dis 2019 Mar;78(3):365–371.
Jesus D, Larosa M, Henriques C, Matos A, Zen M, Tomé P, Alves V, Costa N, Le Guern V, Iaccarino L, Costedoat-Chalumeau N, Doria A, Inês LS. Systemic Lupus Erythematosus Disease Activity Score (SLE-DAS) enables accurate and user-friendly definitions of clinical remission and categories of disease activity. Ann Rheum Dis 2021 Dec;80(12):1568–1574.
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