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OP0092 Remission in Sle: Consensus Findings from a Large International Panel on Definitions of Remission in SLE (DORIS)
  1. R.F. van Vollenhoven1,
  2. C. Aranow2,
  3. G. Bertsias3,
  4. E. Bonfá4,
  5. R. Cervera5,
  6. N. Costedoat-Chalumeau6,
  7. T. Dörner7,
  8. F. Houssiau8,
  9. K. Lerstrom9,
  10. E. Morand10,
  11. M. Mosca11,
  12. S. Navarra12,
  13. M. Petri13,
  14. M. Urowitz14,
  15. A. Voskuijl15,
  16. A. Voss16,
  17. M. Ward17,
  18. V. Werth18,
  19. M. Schneider19
  20. on behalf of the Definitions Of Remission In SLE (DORIS) consensus panel
  1. 1Department of Medicine, Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), The Karolinska Institute, Stockholm, Sweden
  2. 2Feinstein Institute, Manhasset, United States
  3. 3University of Crete, Heraklion, Greece
  4. 4Reumatologia, Sao Paulo, Brazil
  5. 5Universitat de Barcelona, Barcelona, Spain
  6. 6Hôpital Pitié-Salpêtrière, Paris, France
  7. 7Charite, Berlin, Germany
  8. 8UCL, Brussels, Belgium
  9. 9Lupus Europe, Farum, Denmark
  10. 10Monash Medical Center, Victoria, Australia
  11. 11Universita di Pisa, Pisa, Italy
  12. 12University of Santo Tomas Hospital, Manila, Philippines
  13. 13Johns Hopkins University, Baltimore, United States
  14. 14University of Toronto, Toronto, Canada
  15. 15VU Medical Center, Amsterdam, Netherlands
  16. 16Odense University Hospital, Odense, Denmark
  17. 17NIAMS, Bethesda
  18. 18University of Pennsylvania, Philadelphia, United States
  19. 19Herman Hesse University, Dusseldorf, Germany

Abstract

Background Treat-to-target recommendations identified “remission” as a target in SLE but recognize that there is no generally accepted definition for remission in this disease.

Objectives To achieve consensus, in a large multi-party international panel, on potential definitions for remission in SLE.

Methods An international expert panel of sixty rheumatologists, nephrologists, dermatologists, clinical immunologists, and patient representatives participated in preparatory exercises, a full-day face-to-face meeting, and follow-up exercises and electronic voting rounds.

Results Eight key statements regarding remission in SLE achieved >90% agreement (table). There were different viewpoints on the required duration of remission. In addition, the panel expressed strong support (>90%) for the following principles which will guide the further development of remission definitions:

I. A definition of remission in SLE will be worded as follows: Remission in SLE is a durable state characterized by [a definition of: absence of symptoms, signs, abnormal labs, (serology)]

Ia. Remission-off-therapy requires the patient to be on no other treatment for SLE than maintenance antimalarials.

Ib. Remission-on-therapy allows patients to be treated with maintenance antimalarials, stable, low-dose steroids (prednisone ≤5 mg/d), maintenance immunosuppressives and/or stable (maintenance) biologics.

II. Assessment of clinical symptoms and signs should be based on a validated index, e.g., clinical-SLEDAI =0, BILAG D/E only, clinical ECLAM =0; supplemented with PhysGA <0.5 (0-3), and with labs included.

III. For testing the construct validity of each potential remission definition the most appropriate outcomes (dependent variables) are: Death, Damage, Flares, and HR-QOL measures.

Conclusions The work of this international consensus panel provides a framework for testing individual definitions of remission against longer-term outcomes.

Disclosure of Interest R. van Vollenhoven Grant/research support from: AbbVie, BMS, GSK, UCB, Consultant for: AbbVie, Biotest, BMS, Crescendo, GSK, Janssen, Lilly, Merck, Pfizer, Roche, UCB, Vertex, C. Aranow: None declared, G. Bertsias: None declared, E. Bonfá: None declared, R. Cervera: None declared, N. Costedoat-Chalumeau: None declared, T. Dörner: None declared, F. Houssiau: None declared, K. Lerstrom: None declared, E. Morand: None declared, M. Mosca: None declared, S. Navarra: None declared, M. Petri: None declared, M. Urowitz: None declared, A. Voskuijl: None declared, A. Voss: None declared, M. Ward: None declared, V. Werth: None declared, M. Schneider: None declared

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