Yanjie Hao, Dylan Hansen, Rangi Kandane-Rathnayake, Worawit Louthrenoo, Yi-Hsing Chen, Jiacai Cho, Aisha Lateef, Laniyati Hamijoyo, Shue Fen Luo, Yeong-Jian Jan Wu, Sandra Navarra, Leonid Zamora, Zhanguo Li, Sargunan Sockalingam, Yasuhiro Katsumata, Masayoshi Harigai, Zhuoli Zhang, Madelynn Chan, Jun Kikuchi, Tsutomu Takeuchi, Sang-Cheol Bae, Fiona Goldblatt, Sean O'Neill, Kristine Pek Ling Ng, Annie Law, Bmdb Basnayake, Nicola Tugnet, Sunil Kumar, Cherica Tee, Michael Tee, Naoaki Ohkubo, Yoshiya Tanaka, Shirley Chan, C S Lau, Vera Golder, Alberta Hoi, Shereen Oon, Eric Morand, Mandana Nikpour
{"title":"临床活动性疾病SLE患者低疾病活动性和缓解的患病率、决定因素和结局。","authors":"Yanjie Hao, Dylan Hansen, Rangi Kandane-Rathnayake, Worawit Louthrenoo, Yi-Hsing Chen, Jiacai Cho, Aisha Lateef, Laniyati Hamijoyo, Shue Fen Luo, Yeong-Jian Jan Wu, Sandra Navarra, Leonid Zamora, Zhanguo Li, Sargunan Sockalingam, Yasuhiro Katsumata, Masayoshi Harigai, Zhuoli Zhang, Madelynn Chan, Jun Kikuchi, Tsutomu Takeuchi, Sang-Cheol Bae, Fiona Goldblatt, Sean O'Neill, Kristine Pek Ling Ng, Annie Law, Bmdb Basnayake, Nicola Tugnet, Sunil Kumar, Cherica Tee, Michael Tee, Naoaki Ohkubo, Yoshiya Tanaka, Shirley Chan, C S Lau, Vera Golder, Alberta Hoi, Shereen Oon, Eric Morand, Mandana Nikpour","doi":"10.1002/acr.25640","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to identify the frequency and determinants of Lupus Low Disease Activity State (LLDAS) and Definition of Remission in SLE (DORIS-remission) attainment in systemic lupus erythematosus (SLE) patients with clinically active disease, and the frequency and determinants of flare and damage accrual after target attainment.</p><p><strong>Methods: </strong>Patients in a multi-national SLE cohort who had clinical disease activity but were not in LLDAS or DORIS-remission were followed prospectively.</p><p><strong>Results: </strong>1991 patients (93.2% female) were followed for a median (IQR) of 2.5 (0.7-4.5) years, with 70.9% and 55.6% achieving LLDAS and DORIS-remission, respectively. Nephritis and low complements were associated with a longer time, and antimalarial and immunosuppressant use were associated with a shorter time to LLDAS attainment. After the first LLDAS and DORIS-remission attainment, 47.0% and 47.5% of the patients experienced flare(s), respectively, and 9.5% and 7.9 % of patients accrued organ damage within 24 months, respectively. Longer cumulative time at target and antimalarial use was associated with a longer time to flare and damage accrual, while dose reduction in glucocorticoids and immunosuppressants was associated with a shorter time to flare. Reduction in immunosuppressants also correlated with a shorter time to damage accrual.</p><p><strong>Conclusions: </strong>In SLE patients with clinical disease activity, the proportion attaining LLDAS and DORIS-remission under usual care conditions is suboptimal. Longer maintenance of these states is significantly associated with reduced risk of flare. As flares and damage accrual still occur frequently following initial target attainment, further research is needed to inform strategies for maintaining these targets.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.3000,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prevalence, determinants and outcomes of low disease activity and remission attainment in SLE patients with clinically active disease.\",\"authors\":\"Yanjie Hao, Dylan Hansen, Rangi Kandane-Rathnayake, Worawit Louthrenoo, Yi-Hsing Chen, Jiacai Cho, Aisha Lateef, Laniyati Hamijoyo, Shue Fen Luo, Yeong-Jian Jan Wu, Sandra Navarra, Leonid Zamora, Zhanguo Li, Sargunan Sockalingam, Yasuhiro Katsumata, Masayoshi Harigai, Zhuoli Zhang, Madelynn Chan, Jun Kikuchi, Tsutomu Takeuchi, Sang-Cheol Bae, Fiona Goldblatt, Sean O'Neill, Kristine Pek Ling Ng, Annie Law, Bmdb Basnayake, Nicola Tugnet, Sunil Kumar, Cherica Tee, Michael Tee, Naoaki Ohkubo, Yoshiya Tanaka, Shirley Chan, C S Lau, Vera Golder, Alberta Hoi, Shereen Oon, Eric Morand, Mandana Nikpour\",\"doi\":\"10.1002/acr.25640\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>This study aimed to identify the frequency and determinants of Lupus Low Disease Activity State (LLDAS) and Definition of Remission in SLE (DORIS-remission) attainment in systemic lupus erythematosus (SLE) patients with clinically active disease, and the frequency and determinants of flare and damage accrual after target attainment.</p><p><strong>Methods: </strong>Patients in a multi-national SLE cohort who had clinical disease activity but were not in LLDAS or DORIS-remission were followed prospectively.</p><p><strong>Results: </strong>1991 patients (93.2% female) were followed for a median (IQR) of 2.5 (0.7-4.5) years, with 70.9% and 55.6% achieving LLDAS and DORIS-remission, respectively. Nephritis and low complements were associated with a longer time, and antimalarial and immunosuppressant use were associated with a shorter time to LLDAS attainment. After the first LLDAS and DORIS-remission attainment, 47.0% and 47.5% of the patients experienced flare(s), respectively, and 9.5% and 7.9 % of patients accrued organ damage within 24 months, respectively. Longer cumulative time at target and antimalarial use was associated with a longer time to flare and damage accrual, while dose reduction in glucocorticoids and immunosuppressants was associated with a shorter time to flare. Reduction in immunosuppressants also correlated with a shorter time to damage accrual.</p><p><strong>Conclusions: </strong>In SLE patients with clinical disease activity, the proportion attaining LLDAS and DORIS-remission under usual care conditions is suboptimal. Longer maintenance of these states is significantly associated with reduced risk of flare. As flares and damage accrual still occur frequently following initial target attainment, further research is needed to inform strategies for maintaining these targets.</p>\",\"PeriodicalId\":8406,\"journal\":{\"name\":\"Arthritis Care & Research\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2025-09-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Arthritis Care & Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/acr.25640\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RHEUMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthritis Care & Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/acr.25640","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
Prevalence, determinants and outcomes of low disease activity and remission attainment in SLE patients with clinically active disease.
Objectives: This study aimed to identify the frequency and determinants of Lupus Low Disease Activity State (LLDAS) and Definition of Remission in SLE (DORIS-remission) attainment in systemic lupus erythematosus (SLE) patients with clinically active disease, and the frequency and determinants of flare and damage accrual after target attainment.
Methods: Patients in a multi-national SLE cohort who had clinical disease activity but were not in LLDAS or DORIS-remission were followed prospectively.
Results: 1991 patients (93.2% female) were followed for a median (IQR) of 2.5 (0.7-4.5) years, with 70.9% and 55.6% achieving LLDAS and DORIS-remission, respectively. Nephritis and low complements were associated with a longer time, and antimalarial and immunosuppressant use were associated with a shorter time to LLDAS attainment. After the first LLDAS and DORIS-remission attainment, 47.0% and 47.5% of the patients experienced flare(s), respectively, and 9.5% and 7.9 % of patients accrued organ damage within 24 months, respectively. Longer cumulative time at target and antimalarial use was associated with a longer time to flare and damage accrual, while dose reduction in glucocorticoids and immunosuppressants was associated with a shorter time to flare. Reduction in immunosuppressants also correlated with a shorter time to damage accrual.
Conclusions: In SLE patients with clinical disease activity, the proportion attaining LLDAS and DORIS-remission under usual care conditions is suboptimal. Longer maintenance of these states is significantly associated with reduced risk of flare. As flares and damage accrual still occur frequently following initial target attainment, further research is needed to inform strategies for maintaining these targets.
期刊介绍：
Arthritis Care & Research, an official journal of the American College of Rheumatology and the Association of Rheumatology Health Professionals (a division of the College), is a peer-reviewed publication that publishes original research, review articles, and editorials that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with rheumatic diseases, major topics are evidence-based practice studies, clinical problems, practice guidelines, educational, social, and public health issues, health economics, health care policy, and future trends in rheumatology practice.
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