Purpose Lupus Low Disease Activity State (LLDAS) was defined and validated in 2016 by a panel of lupus experts. When attained, it seems to be associated with prediction of clinical improvement and allow a treat-2-target (T2T) approach in clinical care. LLDAS definition was applied to the cohort of SLE patients followed at our Autoimmune Disease Unit and correlated with damage accrual.
Methods Demographic, clinical and immunological features were recorded at baseline. Data were prospectively collected from January 2013 to July 2017. At each consultation during the study period, disease activity, current therapy and fulfilment of LLDAS were registered, except for the Physician Global Assessment which was not recorded. Organ damage progression was evaluated by SLICC damage index at inclusion and at the last evaluation. Spearman´s rho test was used, with p<0.05 considered statistically significant (SPSS Statistics, version 23.0).
Results 76 patients were included: 93.4% females, 88.2% Caucasian, mean age and mean disease duration at inclusion 45.9±13.3 and 14.0±8.3 years, mean of follow-up at recruitment of 9.4±5.1 years. Overall, 1043 visits were performed. As regards LLDAS achievement, 90.8% of patients were in LLDAS at least in 25% of the time, 76.3% at least in 50%, 55.3% at least in 75%, 31.6% at least in 90% and 15.8% for the entire follow-up. At the last observation 33 patients (43.4%) were on treatment with glucocorticoids, 42.1% had their dose reduced during the study and 86,8% were under a dose of 7.5 mg daily; 8 patients were taking belimumab, 2 rituximab and 2 cyclophosphamide. Median SLICC at onset and last visit were 0 and 1, respectively, and IQR SLICC was the same (IQR, −1.5–2.5). The time in LLDAS was associated to less number of global flares (CC −0.541, p<0.001) but no correlation was found with organ injury (CC −0.013, p<0.911).
Conclusions Majority of our patients were in LLDAS during the follow-up period of 4.5 years. LLDAS was associated with less global flares, but not with reduced organ damage. Further studies are important in order to conclude if these targets could be attained more actively with T2T approaches.
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