Journal article
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
Annals of the rheumatic diseases, v 81(11), pp 1541-1548
01 Nov 2022
PMID: 35944946
Featured in Collection : UN Sustainable Development Goals @ Drexel
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.
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Details
- 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
- Creators
- Manuel Francisco Ugarte-Gil - Univ Cient Sur, Grp Peruano Estudio Enfermedades Autoinmunes Sist, Lima, PeruJohn Hanly - Queen Elizabeth II Health Sciences CentreMurray Urowitz - Krembil Research InstituteCaroline Gordon - University of BirminghamSang-Cheol Bae - Hanyang UniversityJuanita Romero-Diaz - Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránJorge Sanchez-Guerrero - Sinai Health SystemSasha Bernatsky - McGill UniversityAnn Elaine Clarke - University of CalgaryDaniel J. Wallace - Cedars-Sinai Medical CenterDavid Alan Isenberg - University College LondonAnisur Rahman - University College LondonJoan T. Merrill - Oklahoma Medical Research FoundationPaul R. Fortin - Université LavalDafna D. Gladman - Krembil Research InstituteIan N. Bruce - Manchester Academic Health Science CentreMichelle Petri - Johns Hopkins MedicineEllen M. Ginzler - SUNY Downstate Health Sciences UniversityMary Anne Dooley - University of North Carolina at Chapel HillRosalind Ramsey-Goldman - Northwestern UniversitySusan Manzi - Allegheny Health NetworkAndreas Jonsen - Lund UniversityRonald F. van Vollenhoven - Amsterdam University Medical CentersCynthia Aranow - Feinstein Institute for Medical ResearchMeggan Mackay - Feinstein Institute for Medical ResearchGuillermo Ruiz-Irastorza - BioCruces Health research InstituteSam Lim - Emory UniversityMurat Inanc - Istanbul UniversityKen Kalunian - College Station Medical CenterSoren Jacobsen - University of CopenhagenChristine Peschken - University of ManitobaDiane L. Kamen - Medical University of South CarolinaAnca Askanase - Columbia University Irving Medical CenterBernardo A. Pons-Estel - Hospital Provincial de RosarioGraciela S. Alarcon - University of Alabama at Birmingham
- Publication Details
- Annals of the rheumatic diseases, v 81(11), pp 1541-1548
- Publisher
- Bmj Publishing Group
- Number of pages
- 8
- Grant note
- U01DP005119 / Centers for Disease Control and Prevention; United States Department of Health & Human Services; Centers for Disease Control & Prevention - USA Arthritis Research UK, the NIHR Manchester Biomedical Centre NIHR/Wellcome Trust Manchester Clinical Research Facility; Wellcome Trust A3865 / Danish Rheumatism Association A05990 / Novo Nordisk Foundation; Novocure Limited Lupus UK AR43727; 69572; 5UL1TR001422-02; UL-1RR-025741; K24-AR-02318; P60AR064464; formerly P60-AR-48098; RR00046 / NIH; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA Singer Family Fund for Lupus Research National Institute for Health Research University College London Hospitals Biomedical Research Centre Universidad Cientifica del Sur
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- General Internal Medicine
- Web of Science ID
- WOS:000838791500001
- Scopus ID
- 2-s2.0-85136542044
- Other Identifier
- 991021934008404721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Rheumatology