May 11, 2020
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Clinical SLE Disease Activity Index of 0 most attainable definition of lupus remission

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A clinical SLE Disease Activity Index score of 0 was the most obtainable definition of remission in systemic lupus erythematosus, and best predicted damage progression in the short-to-mid-term, according to findings published in the Annals of the Rheumatic Diseases.

“Remission is the most desirable target in the management of systemic lupus erythematosus (SLE), as it leads to a significant improvement across several disease outcome measures (death, organ damage, disease flare-up and health-related quality of life (HRQoL)); however, a universally accepted definition of remission combining evidence-based medicine and expert opinion is still missing,” Francesca Saccon, of the University of Padua, in Italy, and colleagues wrote.

They added, “To our knowledge, no head-to-head comparisons were made on the impact of each item or combination of items included in the definitions of remission proposed by the DORIS task force (ie, cSLEDAI = 0, PGA < 0.5, PDN 5mg/day) on disease outcomes in a clinical practice setting.”

To test the performance of these measures — both alone and in combination — in defining remission and predicting progression, Saccon and colleagues studied seven potential definitions of SLE remission among 646 patients, followed for at least 5 years. Participants were recruited from seven referral lupus centers in Italy. The seven remission definitions included prednisone at 5mg or less per day, physician’s global assessment (PGA) of less than 0.5, clinical SLE Disease Activity Index (cSLEDAI) score of 0, PGA of less than 0.5plus prednisone 5mg or less per day, cSLEDAI of 0plus PGA of less than 0.5, cSLEDAI of 0plus prednisone at 5mg or less per day, and, lastly, a combination of all three measures.

 
A clinical SLE Disease Activity Index score of 0 was the most obtainable definition of remission in SLE, and best predicted damage progression in the short-to-mid-term, according to findings.
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The researchers used Poisson regression analysis to analyze the various definitions’ impact on damage. Best performance was determined based on lowest Akaike and Bayesian information criterion (AIC and BIC). Positive and negative predictive values in identifying no damage increase were also calculated.

The researchers reported that at least 2 consecutive years of remission, according to all but one definition, protected against damage. The one exception was prednisone at 5mg or less per day, which required 4 consecutive years (OR = 0.534; 95%CI, 0.325-0.877). Although positive and negative predictive values were similar across all definitions, cSLEDAI score of 0 demonstrated the best performance (AIC = 1082.90, BIC = 1109.72; P < .0001). The addition of a PGA of less than 0.5 and/or prednisone at 5mg or less per day to the cSLEDAI definition decreased remission duration, by –1.8 and –1.5years per patient, respectively, without increasing cSLEDAI performance in predicting damage accrual.

“We confirmed a good agreement between cSLEDAI = 0and PGA < 0.5 in our real-life cohort,” Saccon and colleagues wrote. “Therefore, a simplified remission definition based on cSLEDAI = 0can be reasonably used in observational studies where complete serological data, PGA and BILAG are not routinely assessed.”

They added, “cSLEDAI = 0 was the most achievable definition of remission and showed a good performance in terms of damage prediction, while addition of PGA < 0.5to cSLEDAI = 0 was not relevant in identifying patients who would develop damage, thus submitting cSLEDAI = 0 as the most advisable target in a short-to-mid-term follow-up.” – by Jason Laday

Disclosures: The researchers report no relevant financial disclosures.