For the first time a reduction in mortality has been demonstrated for patients with SLE who achieve a low disease activity state.
Rheumatologists from WA have shown that patients who spend most of the time (>50%) in Lupus Low Disease Activity State (LLDAS-50) have reduced organ damage accrual and also a significantly reduced mortality rate compared to patients who do not achieve low disease activity.
Dr Chanakya Sharma and colleagues from the Sir Charles Gairdner Hospital and the University of Western Australia analysed outcomes for 206 patients with SLE from a Norwegian cohort who were followed up for more than ten years (median 125 months).
They found that one third of patients (69, 33.5%) spent at least half of the follow up time in LLDAS.
For these patients there was a 63% reduced risk of severe damage (Hazard Ratio 0.37 p<0.01) and a 69% reduced risk of in age and sex-adjusted mortality (HR 0.31 p<0.01) compared to those patients who did not achieve LLDAS-50.
Some benefits were also seen for patients who achieved LLDAS for only 30% of follow up, with a significant reduction in mortality (HR 0.36, p < 0.05) and a strong trend towards reduction in risk of severe damage (HR 0.57, p<0.08).
Writing in Arthritis Care and Research, Dr Sharma and colleagues said the findings validated those of a previous study of the LLDAS definition, which found a notable reduction in severe damage among SLE patients who spent greater than 50% of their time in low disease activity state.
The findings also supported a treat-to-target approach, and since there was difficulty in defining and achieving remission in SLE, the LLDAS criteria may provide a more achievable target to guide therapy for patients.
“Our study validates the findings of the inception cohort by demonstrating that achieving LLDAS-50 is associated with a significant reduction in severe damage, but for the first time also demonstrates a reduction in mortality,” they said.
“Thus LLDAS-50 is a practical and achievable surrogate target that is associated with reduced risk of severe damage, mortality and higher quality of life for patients with SLE. ”
A patient is said to be in LLDAS when they meet the following:
- SLE Disease Activity Index (SLEDAI) -2K ≤4, with no activity in major organ systems and no haemolytic anaemia or gastrointestinal activity;
- No new features of lupus disease activity compared with the previous assessment;
- SELENA-SLEDAI physician global assessment (PGA, scale 0–3) ≤1;
- Current prednisolone (or equivalent) dose ≤7.5 mg daily; and,
- Well tolerated standard maintenance doses of immunosuppressive drugs and approved biological agents, excluding investigational drugs