Remission and low disease activity (LDA) prevent damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort

Jacobsen, Soren; Merrill, Joan T.; Aranow, Cynthia; Petri, Michelle; Clarke, Ann Elaine; Bae, Sang-Cheol; Urowitz, Murray; Gordon, Caroline; Hanly, John; Bernatsky, Sasha; van Vollenhoven, Ronald F.; Mackay, Meggan; Fortin, Paul R.; Ruiz-Irastorza, Guillermo; Manzi, Susan; Jonsen, Andreas; Romero-Diaz, Juanita; Askanase, Anca; Ugarte Gil, Manuel Francisco; Sanchez-Guerrero, Jorge; Isenberg, David Alan; Pons-Estel, Bernardo A.; Bruce, Ian N.; Peschken, Christine; Alarcón, Graciela S.; Ramsey-Goldman, Rosalind; Inanc, Murat; Kamen, Diane L.; Lim, Sam; Gladman, Dafna D.; Ginzler, Ellen M.; Dooley, Mary Anne; Rahman, Anisur; Wallace, Daniel J.; Kalunian, Ken

dc.contributor.author	Ugarte Gil, Manuel Francisco
dc.contributor.author	Hanly, John
dc.contributor.author	Urowitz, Murray
dc.contributor.author	Gordon, Caroline
dc.contributor.author	Bae, Sang-Cheol
dc.contributor.author	Romero-Diaz, Juanita
dc.contributor.author	Sanchez-Guerrero, Jorge
dc.contributor.author	Bernatsky, Sasha
dc.contributor.author	Clarke, Ann Elaine
dc.contributor.author	Wallace, Daniel J.
dc.contributor.author	Isenberg, David Alan
dc.contributor.author	Rahman, Anisur
dc.contributor.author	Merrill, Joan T.
dc.contributor.author	Fortin, Paul R.
dc.contributor.author	Gladman, Dafna D.
dc.contributor.author	Bruce, Ian N.
dc.contributor.author	Petri, Michelle
dc.contributor.author	Ginzler, Ellen M.
dc.contributor.author	Dooley, Mary Anne
dc.contributor.author	Ramsey-Goldman, Rosalind
dc.contributor.author	Manzi, Susan
dc.contributor.author	Jonsen, Andreas
dc.contributor.author	van Vollenhoven, Ronald F.
dc.contributor.author	Aranow, Cynthia
dc.contributor.author	Mackay, Meggan
dc.contributor.author	Ruiz-Irastorza, Guillermo
dc.contributor.author	Lim, Sam
dc.contributor.author	Inanc, Murat
dc.contributor.author	Kalunian, Ken
dc.contributor.author	Jacobsen, Soren
dc.contributor.author	Peschken, Christine
dc.contributor.author	Kamen, Diane L.
dc.contributor.author	Askanase, Anca
dc.contributor.author	Pons-Estel, Bernardo A.
dc.contributor.author	Alarcón, Graciela S.
dc.date.accessioned	2022-10-12T18:25:59Z
dc.date.available	2022-10-12T18:25:59Z
dc.date.issued	2022
dc.identifier.uri	https://hdl.handle.net/20.500.12866/12392
dc.description.abstract	Objective To determine the independent impact of different definitions of remission and low disease activity (LDA) on damage accrual. Methods Patients with ≥2 annual assessments from a longitudinal multinational inception lupus cohort were studied. Five mutually exclusive disease activity states were defined: remission off-treatment: clinical Systemic Lupus Erythematosus Disease Activity Index (cSLEDAI)-2K=0, without prednisone or immunosuppressants; remission on-treatment: cSLEDAI-2K score=0, prednisone ≤5 mg/day and/or maintenance immunosuppressants; low disease activity Toronto cohort (LDA-TC): cSLEDAI-2K score of ≤2, without prednisone or immunosuppressants; modified lupus low disease activity (mLLDAS): Systemic Lupus Erythematosus Disease Activity Index-2K score of 4 with no activity in major organ/systems, no new disease activity, prednisone ≤7.5 mg/day and/or maintenance immunosuppressants; active: all remaining visits. Only the most stringent definition was used per visit. Antimalarials were allowed in all. The proportion of time that patients were in a specific state at each visit since cohort entry was determined. Damage accrual was ascertained with the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). Univariable and multivariable generalised estimated equation negative binomial regression models were used. Time-dependent covariates were determined at the same annual visit as the disease activity state but the SDI at the subsequent visit. Results There were 1652 patients, 1464 (88.6%) female, mean age at diagnosis 34.2 (SD 13.4) years and mean follow-up time of 7.7 (SD 4.8) years. Being in remission off-treatment, remission on-treatment, LDA-TC and mLLDAS (per 25% increase) were each associated with a lower probability of damage accrual (remission off-treatment: incidence rate ratio (IRR)=0.75, 95% CI 0.70 to 0.81; remission on-treatment: IRR=0.68, 95% CI 0.62 to 0.75; LDA: IRR=0.79, 95% CI 0.68 to 0.92; and mLLDAS: IRR=0.76, 95% CI 0.65 to 0.89)). Conclusions Remission on-treatment and off-treatment, LDA-TC and mLLDAS were associated with less damage accrual, even adjusting for possible confounders and effect modifiers.	en_US
dc.language.iso	eng
dc.publisher	BMJ Publishing Group
dc.relation.ispartofseries	Annals of the Rheumatic Diseases
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.subject	low disease activity	en_US
dc.subject	systemic lupus erythematosus	en_US
dc.subject	Systemic Lupus International Collaborating Clinics	en_US
dc.title	Remission and low disease activity (LDA) prevent damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort	en_US
dc.type	info:eu-repo/semantics/article
dc.identifier.doi	https://doi.org/10.1136/ard-2022-222487
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.02.17
dc.relation.issn	1468-2060