Table 2

Statements, generated as the result of substantial reviews of the literature and data from individual registries and clinical trial data sets, and supported by the DORIS Task Force

Vote in favourLoEGoRAgreement
1. Inclusion of serology (anti-DNA, complement) in the DORIS definition of remission on-treatment does not meaningfully alter the construct validity and therefore it is not recommended to include it.90%2aB8.38
2. While the goal of treatment is sustained remission, a definition of remission should be able to be met at any point in time; therefore, duration should not be included in the definition.100%5C9.02
3. To date, the SLEDAI-based definitions of remission have formally been investigated more extensively than BILAG-based or ECLAM-based definitions. The SLEDAI-based definitions can therefore more confidently be recommended.91%2aB9.25
4. Remission off-treatment, while the ultimate goal for many patients and care providers, is achieved very rarely. In clinical research and as an outcome in clinical trials, the definition for remission on-treatment is recommended.92%2aB9.52
5. In clinical trials, the LLDAS definition for low disease activity and the DORIS definition of remission are both recommended as outcomes.100%5C9.25
Final recommendation:
The task force supports the 2021 DORIS definition of remission in SLE: cSLEDAI=0 and PhGA <0.5, irrespective of serology; the patient may be on antimalarials, low-dose glucocorticoids (prednisolone <5 mg/day), and/or stable immunosuppressives including biologics.
  • Agreement=the average of individual task force members’ agreements with the statement on a scale of 1–10.

  • Note that GoRs were not easily applied to recommendations 2 and 5; we considered these consensus statements to be ‘extrapolations from level 2 or 3 studies’, yielding a GoR of C.

  • BILAG, British isles lupus assessment group; cSLEDAI, clinical SLEDAI; DORIS, Definitions Of Remission In SLE; ECLAM, European consensus lupus activity measure; GoR, grade of recommendation; LLDAS, lupus low disease activity state; LoE, level of evidence; PhGA, Physician Global Assessment; SLEDAI, systemic lupus erythematosus disease activitiy index.