Background The definition of an accurate target for a treat to target (T2T) approach in SLE has been challenging over the past years. Recently four definitions of remission were presented by the international DORIS task force. Aim of this study was to evaluate the frequency of remission in our outpatient SLE cohort and to assess feasibility and concordance of the remission definitions with the treating physicians opinion regarding the patients state.
Methods In this monocentric cross-sectional study patients with SLE according to the 1997 American College of Rheumatology (ACR) criteria were enrolled and assessed between September 2016 and December 2017. DORIS remission definitions were applied and demographic and laboratory data as well as disease activity (SLEDAI), steroid dosage and physician global assessment were evaluated. After the clinical consultation, the treating physicians answered the question if his/her patient was in remission.
Results A total of 233 patients were included (87.6% female). 88 (37.8%) patients fulfilled any of the four DORIS remission definitions, while 129 patients were in remission according to their physicians judgement. Of the 88 in DORIS remission, 17 were in complete remission, 20 in clinical remission, 16 in complete remission on treatment (ROT) and 35 in clinical ROT. In most cases the treating physician agreed on their patient being in remission (94.1% for complete remission, 90.0% for clinical remission, 81.3% for complete ROT, 88.6% for clinical ROT). A total of 145 patient were not in any DORIS remission. We observed discordance in the assessment of remission in 58 patients (24.9%), 10/88 being not in remission according to their treating physician despite fulfilling the DORIS remission definition and 48/145 were considered in remission though not in DORIS remission. Reasons for failing DORIS remission in the patients with attested physicians remission were an elevated cSLEDAI Score (n=22), elevated (n=24) or missing (n=1) physician global assessment, and prednisolone dosage >5 mg (n=9).
Conclusions DORIS remission proved an achievable target in our outpatient clinic. Still we found discordance regarding DORIS remission and the treating physicians judgement with a greater number of patients considered in remission by their physicians. Main reasons were a cSLEDAI >0 and physician global assessment >0.5. Further analyses are needed to better characterize cases of disagreement and to address the question, if the rather strict DORIS criteria are needed to improve long-term outcome.
Funding Source(s): None
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