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Abstract
Introduction An accurate target in Systemic Lupus Erythematosus (SLE) Treat to Target strategies has been challenging over the past years. Recently, a new definition of remission was updated in 2021 by the international DORIS (Definition of Remission in SLE) taskforce.
Objective To quantify the proportion of patients who achieve DORIS and evaluate the agreement between DORIS and the treating rheumatologist judgement.
Methods Prospective multicenter study of SLE patients (ACR 1997 Classification Criteria or Clinical diagnosis by the Physician) from seven Spanish Rheumatology Departments. DORIS 2021 remission definition was applied and the rheumatologists were asked to classified the activity of the disease in 5 different categories: remission, serologically active clinically quiescent (SACQ), low, moderate or high activity. Statistical analysis: descriptive cross-sectional (at the time of recruitment) analysis was done. Analysis of the level of agreement between expert opinion and the definition of remission was evaluated using Cohen’s kappa. The reasons of disagreement were evaluated.
Results A total of 508 patients were included (92% women; mean age (±SD): 50.4 years (±SD 13.7)). Table 1 shows in detail the patients characteristics at baseline. Two hundred and sixty-seven (54.4%) patients were in DORIS 2021 remission. According to the rheumatologist judgement, 206 (41.6%) patients were considered in remission and 71 (14.3%) in a SACQ state (Figure 1). Overall agreement between rheumatologist opinion and DORIS was 81.28% (95% CI: 79.9, 82.9) with a Cohen’s kappa of 0.62. We found disagreement in 46 patients, and the main reasons were a clinical SLEDAI>0 in 39 (84.8%) patients; Physician Global Assessment (PGA) >0.5 in 5 patients and a prednisone dose above 5 mg day in other five patients.
Patient demographics and disease characteristics
Concordance of DORIS and physician remission
Conclusion At a given point in time, more than half of SLE patients were in DORIS 2021 remission. The overall agreement between rheumatologist opinion and DORIS remission is accurate.
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