Background/Purpose: The Asia-Pacific Collaboration Group has recently proposed the definition of Lupus Low Disease Activity state (LLDAS). This potential target in SLE treatment has been applied so far in a few longstanding SLE cohorts with not homogeneous disease duration. The present study aims to assess attainability and outcome of the LLDAS in the early stages of systemic lupus erythematosus (SLE) diagnosis and management.

Methods: LLDAS prevalence was evaluated at 6 (T1) and 18 (T2) months after treatment initiation (T0) in a monocentric cohort of 107 (median disease duration 9.7 months) prospectively followed Caucasian SLE patients. Reasons for failure to achieve LLDAS were also investigated. Multivariate models were built, using co-variates with p<0.1 at univariate analysis, to identify factors associated with failure to LLDAS achievement and to investigate the relationship between LLDAS and SLICC/Damage Index (SDI) accrual.

Results: Forty-seven (43.9%) patients were in LLDAS at T1 and 48 (44.9%) at T2. The most frequent unmet LLDAS criteria was the prednisolone dose ≤7.5mg/day (unmet in 83% of no-LLDAS at T1). The disease manifestations with the highest persistence rate during follow-up were: increased anti-dsDNA (persistently present in 85.7% and 67.5% of cases at T1 and T2, respectively), low complement (73.2% and 66.3%) and renal abnormalities (46.4% and 28.6%). Renal involvement at T0 was significantly associated with failure to achieve LLDAS both at T1 (OR: 7.8, 95%CI: 1.41-43.40; p=0.019) and T2 (OR: 3.87, 95%CI 1.41-10.6; p=0.008). In regard of organ damage, 27 SDI-items (9 of them steroid-related) were recorded in 23 (21.5%) patients at T2. Presence of any organ damage (SDI ≥1) at T2 was significantly associated to no-LLDAS at T1 (OR: 5.01, 95%CI 1.51-16.63; p=0.009) and age at diagnosis (OR: 1.05 per year, 95%CI 1.01-1.09; p=0.020.

Conclusion: LLDAS is a promising target in the early stages of SLE management being attainable and negatively associated to damage accrual. However, it seems to poorly fit to patients with renal involvement and a greater consensus should be reached on the definition of significant serological disorders and minimal acceptable prednisolone dose.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/achievement-of-lupus-low-disease-activity-state-lldas-in-the-early-phase-of-systemic-lupus-erythematosus-prevent-damage-accrual/