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  • P70 Exposure to DORIS ≥50% of time and to LLDAS ≥60% of observation time exhibit the best combination of feasibility and protection against adverse outcomes in moderate-to-severe SLE

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Poster Presentations
P70 Exposure to DORIS ≥50% of time and to LLDAS ≥60% of observation time exhibit the best combination of feasibility and protection against adverse outcomes in moderate-to-severe SLE
  1. Sofia Pitsigavdaki1,
  2. Myrto Nikoloudaki1,
  3. Panagiotis Garantziotis2,3,
  4. Ettore Silvagni4,
  5. Argyro Repa1,
  6. Antonio Marangoni4,
  7. Irini Flouri1,
  8. Nestor Avgoustidis1,
  9. Konstantinos Parperis5,
  10. Marcello Govoni4,
  11. Prodromos Sidiropoulos1,6,
  12. Dimitrios Boumpas3,7,
  13. Alessandra Bortoluzzi4 and
  14. George Bertsias1,6
  1. 1Rheumatology and Clinical Immunology, University of Crete Medical School, Heraklion, Greece
  2. 2Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
  3. 3Laboratory of Autoimmunity and Inflammation, Centre of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation Academy of Athens, Athens, Greece
  4. 4Rheumatology Clinic, University of Ferrara, Ferrara, Italy
  5. 5Division of Rheumatology, Department of Medicine, University of Cyprus Medical School, Nicosia, Cyprus
  6. 6Division of Immunity, Institute of Molecular Biology and Biotechnology-Foundation for Research and Technology – Hellas (FORTH), Heraklion, Greece
  7. 7Rheumatology and Clinical Immunology Unit, 4th Department of Internal Medicine, Attikon University Hospital, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece

Abstract

Objective We assessed the attainment of remission (DORIS) and lupus low disease activity state (LLDAS) in patients with active moderate-to-severe disease and the minimum time dependent exposure associated to lower risk for organ damage accrual and severe disease flares. Thus far, the feasibility of these targets has been validated particularly in unselected SLE cohorts and observational studies, posing a question to their feasibility in difficult to treat patients.

Methods This is a retrospective cohort study of SLE patients aged ≥16 years who fulfilled the 2012 Systemic Lupus International Collaborating Clinics (SLICC) and/or 2019 EULAR/American College of Rheumatology (ACR) classification criteria for SLE, that were followed in two Rheumatology centres. Active SLE was defined as Physician Global Assessment≥1.5 and/or SLEDAI-2K≥6, requiring therapy intensification. Screening medical records from the past and forward in time, patients were included from the first occurrence of active disease and data were prospectively collected from subsequent visits. DORIS, LLDAS, organ damage (SLICC/ACR damage index) and flares were monitored. Shared frailty survival and generalized linear models were applied.

Results A total 348 patients (92.8% females) were monitored over 60 (27) (median [IQR]) months with 10 (4) visits per patient and 6.0 (3.0) months between-visit interval. At inclusion, 53.7% of patients had PGA ≥2 (median [IQR] 2.0 [0.5]) and 64.7% had clinical SLEDAI-2K (excluding serology) ≥6 (median [IQR] 6 [4]), both demonstrative of moderate-high activity/severity. Sustained (≥2 consecutive visits) DORIS and LLDAS occurred in 38.8% and 77.6%, respectively. DORIS and LLDAS led to reduction of subsequent damage accrual (hazard ratio [HR]:0.64; [95%CI] 0.42–0.97 and 0.63;0.46–0.89) and severe flares (HR:0.34;0.22–0.51 and 0.39;0.29–0.51) respectively. Generalized linear models fitting increasing duration of targets, showed that DORIS ≥50% and LLDAS ≥60% of observation time had the best balance between attainability (23.3% and 41.7%) and specificity (85.2% and 73.3%) for damage-free progression (figure 1). Importantly, these targets were also linked to reduced risk for serious adverse events (risk ratio [RR]:0.56–0.71), hospitalizations (RR:0.70) and mortality (RR:0.06–0.13).

Conclusion In moderate-to-severe SLE, remission and LLDAS are feasible goals that protect against multiple disease and patient-related outcomes. Observation time exposure-defined DORIS/LLDAS targets can be useful in treat-to-target strategies and clinical studies.

Abstract P70 Figure 1
Abstract P70 Figure 1
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/lupus-2024-el.124

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