Golder, Vera and Kandane-Rathnayake, Rangi and Li, Ning and Louthrenoo, Worawit and Chen, Yi-Hsing and Cho, Jiacai and Lateef, Aisha and Hamijoyo, Laniyati and Luo, Shue Fen and Wu, Yeong-Jian and Navarra, Sandra and Zamora, Leonid and Li, Zhanguo and Sockalingam, Sargunan and Katsumata, Yasuhiro and Harigai, Masayoshi and Hao, Yanjie and Zhang, Zhuoli and Basnayake, Duminda and Chan, Madelynn and Kikuchi, Jun and Takeuchi, Tsutomu and Bae, Sang-Cheol and Goldblatt, Fiona and Oon, Shereen and O'Neill, Sean and Ng, Kristine and Law, Annie and Tugnet, Nicola and Kumar, Sunil and Tee, Cherica and Tee, Michael and Ohkubo, Naoaki and Tanaka, Yoshiya and Lau, Chak Sing and Hoi, Alberta and Nikpour, Mandana and Morand, Eric F. and Collaboration, Asia Pacific Lupus (2024) Association of sustained lupus low disease activity state with improved outcomes in systemic lupus erythematosus: a multinational prospective cohort study. Lancet Rheumatology, 6 (8). e528-e536. ISSN 2665-9913, DOI https://doi.org/10.1016/S2665-9913(24)00121-8.
Full text not available from this repository.Abstract
Background Validation of protective associations of the lupus low disease activity state (LLDAS) against flare, irreversible damage, health-related quality of life, and mortality has enabled the adoption of treat-to-target strategies patients with systemic lupus erythematosus (SLE). Previous validation studies were of short duration, limiting the ability to detect longer term signals in flare rate and irreversible damage. In addition, previous studies have focused on percent time at target, rather than actual periods of time that are more useful in clinical practice and trials. We assessed long-term protective associations of LLDAS and remission, and specifically examined protective thresholds of sustained LLDAS and remission. Methods Patients aged 18 years or older with SLE were followed up from May 1, 2013, to Dec 31, 2020 in a prospective, multinational, longitudinal cohort study. Patients were recruited from 25 centres in 12 countries. Multi-failure time--event analyses were used to assess the effect of sustained LLDAS on irreversible damage accrual (primary outcome; measured with the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index) and flare (key secondary outcome; measured with the SELENA Flare Index), with dose exposure and threshold effects studied. Sustained LLDAS or remission were defined as two or more consecutive visits over at least 3 months the respective state. This study is registered with ClinicalTrials.gov, NCT03138941. Findings 3449 patients were followed up for a median of 2<middle dot>8 years (IQR 1<middle dot>1-5<middle dot>6), totalling 37 662 visits. 3180 (92<middle dot>2%) patients were women, and 3031 (87<middle dot>9%) were of Asian ethnicity. 2506 (72<middle dot>7%) patients had sustained LLDAS at least once. Any duration of sustained LLDAS or remission longer than 3 months was associated with reduced damage accrual (LLDAS: hazard ratio 0<middle dot>60 95% CI 0<middle dot>51-0<middle dot>71], p<0<middle dot>0001; remission: 0<middle dot>66 0<middle dot>57-0<middle dot>76], p<0<middle dot>0001) and flare (LLDAS: 0<middle dot>56 0<middle dot>51-0<middle dot>63], p<0<middle dot>0001; remission: 0<middle dot>66 0<middle dot>60-0<middle dot>73], p<0<middle dot>0001), and increasing durations of sustained LLDAS corresponded to increased protective associations. Sustained DORIS remission or steroid-free remission were less attainable than LLDAS. Interpretation We observed significant protective associations of LLDAS and remission against damage accrual and flare, establish a threshold of 3 months sustained LLDAS or remission as protective, and demonstrate deepening protection with longer durations of sustained LLDAS or remission.
| Item Type: | Article |
|---|---|
| Funders: | AstraZeneca, Bristol-Myers Squibb, Eli Lilly, UCB Pharma SA, EMD Sereno, GlaxoSmithKline, Johnson & Johnson Johnson & Johnson USA Janssen Biotech Inc |
| Subjects: | R Medicine > R Medicine (General) |
| Divisions: | Faculty of Medicine > Medicine Department |
| Depositing User: | Ms. Juhaida Abd Rahim |
| Date Deposited: | 27 Mar 2025 06:23 |
| Last Modified: | 27 Mar 2025 06:23 |
| URI: | http://eprints.um.edu.my/id/eprint/46791 |
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