Background Lupus Low Disease Activity State (LLDAS) is a consensus-based definition of minimally acceptable disease activity in patients with Systemic lupus erythematosus (SLE).
Objectives The aims of this study were to evaluate what proportion of patients with LN fulfils the definition of LLDAS and to evaluate the effect of LLDAS attainment on damage accrual over a period of 5 years.
Methods This is a retrospective analysis of data prospectively collected in a longitudinal observational cohort of LN patients. The conceptual definition of LLDAS is a state, which if sustained, is associated with good long-term outcomes. The operational definition of LLDAS is fulfilled when all of the following criteria are met: (1) SLE Disease Activity Index (SLEDAI-2 K) ≤4, with no activity in major organ systems (renal, central nervous system, cardiopulmonary, vasculitis, fever) and no haemolytic anaemia or gastrointestinal activity; (2) no new features of lupus disease activity compared to the previous assessment; (3) a Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA)-SLEDAI physician global assessment (PGA) (scale 0–3) ≤1; (4) a current prednisolone (or equivalent) dose ≤7,5 mg daily; and (5) well-tolerated standard maintenance doses of immunosuppressive drugs and approved biologic agents, excluding investigational drugs. The definition of LLDAS was applied to each patient for each visit; organ damage was calculated with the SLICC/DI score (SDI) at study entry and at last observation.
Results 294 patients were eligible for the study (89.79% females, mean age at first visit 31,4±11,9 years, mean disease duration at last visit 19,8±8,7 years). At last observation 219 patients (85,37%) were on treatment with glucocorticoids (GC) and/or immunomodulators. According with all the items of the definition, at last observation LLDAS was present in 146 patients (49,65%); among these, 37 patients (20,8%) maintained a stable LLDAS during the last 5 years of follow-up (LLDAS fulfilled for all visits). 68 patients (23,12%) accrued organ damage during the follow-up; in the cohort as a whole the mean increase in SDI was 0,4±0.67 resulting in a mean final SDI of 1,2±1,8. Patients who maintained LLDAS were younger (p<0,05), had a lower disease activity score at study entry (p<0,001) and were more likely GC-free at last observation (p<0,001). Patients who maintained LLDAS accrued less organ damage but this difference did not reach statistical significance.
Conclusions High percentage of patients fulfils the proposed definitions for LLDAS at last visit but only a minority maintained this state for all the follow-up period. A minimally acceptable disease activity state is associated with a successful GC tapering and, probably, better long-term outcomes. LLDAS was shown to be associated with protection from damage accrual.
Disclosure of Interest None declared