Sustained Remission In SLE Is Infrequent On Standard Of Care: A Decade Of Insights From The Asia Pacific Lupus Collaboration

Rangi Kandane-Rathnayake¹, Yi-Hsing Chen², Alberta Hoi³, Vera Golder⁴, Worawit Louthrenoo⁵, Jiacai Cho⁶, Aisha Lateef⁷, Laniyati Hamijoyo⁸, Shue Fen Luo⁹, Yeong-Jian Jan Wu¹⁰, Chiu Wai Shirley Chan¹¹, Leonid Zamora¹², Yasuhiro Katsumata¹³, Sargunan Sockalingam¹⁴, Zhanguo Li¹⁵, Haihong Yao¹⁵, BMDB Basnayake¹⁶, Yih Jia Poh¹⁷, Yanjie Hao¹⁸, Zhuoli Zhang¹⁹, Madelynn Chan²⁰, Jun Kikuchi²¹, Yuko Kaneko²², Tsutomu Takeuchi²³, Shereen Oon²⁴, Kristine Ng²⁵, Sang-Cheol Bae²⁶, Cherica Tee²⁷, Michael Tee²⁷, Nicola Tugnet²⁸, Sean O’Neill²⁹, Geraldine Hassett³⁰, Fiona Goldblatt³¹, Naoaki Ohkubo³², Yusuke Miyazaki³², Mark Sapsford³³, Yoshiya Tanaka³⁴, Sandra Navarra³⁵, Chak Sing Lau³⁶, Mandana Nikpour³⁷ and Eric Morand³⁸, ¹Center for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia, ²Taichung Veterans General Hospital, Division of Allergy, Immunology and Rheumatology, Taichung, Taiwan, Taichung, Taiwan (Republic of China), ³Centre for Inflammatory Diseases, Monash University and Department of Rheumatology, Monash Health, Clayton, Victoria, Australia, ⁴Monash University, Clayton, Australia, ⁵Chiang Mai University Hospital, Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai, Thailand, Chiang Mai, Thailand, ⁶National University Hospital, Rheumatology Division, Department of Medicine, Singapore, Singapore, Singapore, Singapore, ⁷Woodlands Health, Singapore, Singapore, ⁸Padjadjaran University/Hasan Sadikin General Hospital, Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Bandung, Indonesia, Badung, Indonesia, ⁹Chang Gung Memorial Hospital, Chang Gung University, Department of Rheumatology, Allergy and Immunology, Taipei, Taiwan, Taoyuan, Taiwan (Republic of China), ¹⁰Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan (Republic of China), ¹¹Division of Rheumatology and Clinial Immunology, Department of Medicine, the University of Hong Kong, Hong Kong, Hong Kong, China, ¹²University of Santo Tomas Hospital, Manila, Philippines, ¹³Tokyo Women's Medical University, Tokyo, Japan, ¹⁴University of Malaya Medical Center, Kuala Lumpur, Malaysia, ¹⁵Peking University People's Hospital, Beijing, China (People's Republic), ¹⁶National Hospital Kandy, Kandy, Sri Lanka, ¹⁷Singapore General Hospital, Singapore, Singapore, ¹⁸St Vincent’s Hospital Melbourne, Fitzroy, Australia, ¹⁹Peking University First Hospital, Beijing, Beijing, China (People's Republic), ²⁰Tan Tock Seng Hospital, Singapore, Singapore, ²¹Keio University, Tokyo, Japan, ²²Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan, ²³Saitama Medical University and Keio University, Tokyo, Japan, ²⁴St Vincent’s Hospital Melbourne, Melbourne, Victoria, Australia, ²⁵Health New Zealand Waitemata, Te Whatu Ora, Auckland, New Zealand, ²⁶Hanyang University Medical Center, Seoul, South Korea, ²⁷University of the Philippines, Manila, Philippines, ²⁸Health New Zealand Auckland, Te Whatu Ora (Auckland District Health Board), Auckland, New Zealand, ²⁹The University of Sydney, Sydney, Australia, ³⁰Liverpool Hospital, NSW, Liverpool, Australia, ³¹Flinders Medical Centre, Bedford park, Australia, ³²University of Occupational and Environmental Health, Kitakyushu, Japan, ³³Health New Zealand Counties Manukau, Te Whatu Ora (Middlemore Hospital),, Auckland, New Zealand, ³⁴University of Occupational and Environmental Health, Japan, Kitakyushu, Japan, ³⁵University of Santo Tomas, Manila, Philippines, ³⁶The University of Hong Kong, Hong Kong, Hong Kong, ³⁷University of Sydney School of Public Health and Department of Rheumatology, Royal Prince Alfred Hospital, Sydney, Victoria, Australia, ³⁸Centre for Inflammatory Diseases, Monash University and Monash Health, Melbourne, Victoria, Australia

Meeting: ACR Convergence 2025

Keywords: Outcome measures, Systemic lupus erythematosus (SLE)

Session Information

Date: Sunday, October 26, 2025

Title: (0593–0640) Systemic Lupus Erythematosus – Diagnosis, Manifestations, & Outcomes Poster I

Session Type: Poster Session A

Session Time: 10:30AM-12:30PM

Background/Purpose: Treat-to-target (T2T) states in SLE, such as the Lupus Low Disease Activity State (LLDAS) and remission (REM) as defined by the Definitions of Remission in SLE (DORIS), are now reflected in treatment guidelines. However, while sustained attainment of these states is reported in response to CD19 CAR-T treatment, limited long-term data exist quantifying the frequency of sustained attainment of these states on standard of care.

Methods: We examined the cumulative and sustained (continuous) attainment of LLDAS, REM, and steroid-free remission (REM-0) utilising the Asia Pacific Lupus Collaboration (APLC) patient cohort. Data were collected from 25 sites across 13 countries between 1st January 2013 and 31st December 2023 using standardised templates. LLDAS was defined as Golder et al., 2019 (1) (SLEDAI≤4, no new activity, PGA ≤1, prednisolone (PNL) ≤7.5 mg/d, antimalarials (AM) and immunosuppressants (IS) allowed). REM was defined as Vollenhoven et al, 2021 (2) (clinical SLEDAI=0, PGA < 0.5, PNL≤5 mg/d, AM/ IS allowed), while REM-0 was defined as clinical SLEDAI=0, PGA < 0.5, PNL=0 mg/d, AM/ IS allowed. We examined these outcomes in all patients, and in patients who at enrolment were not at target (i.e. not in LLDAS).

Results: A total of 68,083 visits from 5,053 patients with ≥2 visits were evaluated. About 82% of patients attained LLDAS; ~70% attained REM, and 31% attained REM-0 at least once during the observation period. Accordingly, LLDAS was achieved in 48% of visits (n= 31,706); REM in 37% of visits (n= 31,706), and REM-0 in 13.5% of visits (9,189) (Figure 1). Cumulative and sustained attainment of these T2T states were low, especially sustained REM-0 (~14%) (Table 1). Although the proportion of patients attaining sustained REM-0 gradually increased over time, the majority of patients never achieved this state (Figure 2). Overall, patients who attained sustained REM0 were older, had a longer study duration, and had used more AM (88% vs. 84% of sustained REM0-never patients, p=0.015).We further examined the attainment of these T2T states in 2,517 patients who were not at target (i.e. not in LLDAS) at enrolment (51% of the cohort). These patients were younger and had shorter SLE disease duration than those in LLDAS at enrolment. Fewer of these patients attained T2T states; only 18% achieved REM-0 at least once, and < 6% achieved 12 months sustained REM-0 (Table 1).

Conclusion: Sustained attainment of steroid-free remission was infrequent in SLE patients receiving standard of care.References1. Golder V, Kandane-Rathnayake R, Huq M, Nim H, Louthrenoo W, Luo SF, et al. Lupus low disease activity state as a treatment endpoint for systemic lupus erythematosus: a prospective validation study. The Lancet Rheumatology. 2019;1(2):e95–e102.2. van Vollenhoven RF, Bertsias G, Doria A, Isenberg D, Morand E, Petri MA, et al. 2021 DORIS definition of remission in SLE: final recommendations from an international task force. Lupus Sci Med. 2021;8(1).

Table 1 – Patient characteristics

Figure 1: Patient visits fulfilling REM-0

Figure 2 – Attainment of steroid-free remission (REM-0) overtime

Disclosures: R. Kandane-Rathnayake: Bristol-Myers Squibb(BMS), 5, GlaxoSmithKline (GSK), 5, Novartis, 5; Y. Chen: Abbvie, 12,, 2, 6, Agnitio Science Technology, 2, 6, Astellas, 12,, 2, 6, AstraZeneca, 12,, 2, 6, Biogen, 12,, BMS, 12,, 2, 6, Boehringer-Ingelheim, 12,, Celldex, 12,, CSL Behring, 2, 6, Eisai, 2, 6, Gilead, 12,, 2, 6, GSK, 12,, 2, 6, Guigai, 12,, 2, 6, Inova Diagnostics, 2, 5, Johnson & Johnson, 12,, 2, 6, Lilly, 2, 6, Medigen Vaccine Biologics, 12,, MSD, 12,, 2, 6, Novartis, 2, 6, Pfizer, 12,, 2, 6, Roche, 12,, Sanofi, 12,, 2, 6, Taichung Veterans General Hospital, 12,, Taiwan Department of Health, 12,, Taiwan Ministry of Science and Technology, 12,, Thermo Fisher, 2, 6, UCB, 12,, 2, 6, United Biopharma, 2, 6; A. Hoi: AstraZeneca, 1, 5, 12, contract research, Bristol-Myers Squibb(BMS), 5, Eli Lilly, 5, GlaxoSmithKline (GSK), 1, Johnson & Johnson, 1, Merck/MSD, 12, contract research, UCB, 5; V. Golder: None; W. Louthrenoo: None; J. Cho: None; A. Lateef: None; L. Hamijoyo: None; S. Luo: None; Y. Wu: None; C. Chan: None; L. Zamora: None; Y. Katsumata: None; S. Sockalingam: None; Z. Li: ImmuneCare Biopharmaceuticals (Shanghai) Co.,Ltd,, 5; H. Yao: ImmuneCare Biopharmaceuticals (Shanghai) Co.,Ltd, 5; B. Basnayake: None; Y. Jia Poh: None; Y. Hao: None; Z. Zhang: AbbVie/Abbott, 1, 6, Amgen, 6, BMS, 1, Eisai, 5, 6, Eli Lilly, 6, GSK, 6, Novartis, 6, Rongchang Pharmaceutials, 6, Xiansheng Pharmaceutials, 6; M. Chan: None; J. Kikuchi: None; Y. Kaneko: AbbVie/Abbott, 6, Asahi Kasei, 5, 6, Chugai, 5, 6; T. Takeuchi: AbbVie, 2, 6, Astellas Pharma, 6, AstraZeneca, 6, Chugai Pharmaceutical, 6, Eisai, 6, Eli Lilly, 2, 6, Gilead Sciences, 2, 6, Janssen, 6, Mitsubishi Tanabe Pharma, 2, 6, Pfizer, 6, Taisho Pharmaceutical, 2, 6; S. Oon: None; K. Ng: None; S. Bae: None; C. Tee: None; M. Tee: None; N. Tugnet: None; S. O’Neill: None; G. Hassett: None; F. Goldblatt: None; N. Ohkubo: None; Y. Miyazaki: None; M. Sapsford: None; Y. Tanaka: AbbVie, 6, AstraZeneca, 6, BMS, 6, Boehringer Ingelheim, 6, Chugai, 6, Daiichi Sankyo, 6, Eisai, 6, Eli Lilly & Co., 6, Gilead, 6, GSK, 6, IQVIA, 6, Otsuka, 6, Taisho, 6, UCB, 6; S. Navarra: Astellas, 2, 6, AstraZeneca, 2, 6, Aurinia, 2, 6, Biogen, 2, 12, Independent Data Monitoring Committee, Viatris (Idorsia), 2, 6; C. Lau: None; M. Nikpour: AstraZeneca, 2, 6, Boehringer Ingelheim, 2, 5, 6, GSK, 2, 6, Janssen Pharmaceuticals, 2, 5, 6; E. Morand: AbbVie, 2, 5, Amgen, 5, AstraZeneca, 1, 2, 5, 6, Biogen, 1, 2, 5, 6, Bristol Meyers Squibb, 1, 2, 5, 6, Dragonfly, 1, 2, 6, Eli Lilly, 1, 2, 5, 6, EMD Serono, 1, 2, 5, 6, Genentech, 5, GSK, 1, 2, 5, 6, Johnson & Johnson, 5, Novartis, 2, 5, 6, Quell, 1, 2, 6, Remegen, 1, 2, 6, Takeda, 5, UCB, 1, 2, 5, Zenas, 1, 2, 6.

To cite this abstract in AMA style:

Kandane-Rathnayake R, Chen Y, Hoi A, Golder V, Louthrenoo W, Cho J, Lateef A, Hamijoyo L, Luo S, Wu Y, Chan C, Zamora L, Katsumata Y, Sockalingam S, Li Z, Yao H, Basnayake B, Jia Poh Y, Hao Y, Zhang Z, Chan M, Kikuchi J, Kaneko Y, Takeuchi T, Oon S, Ng K, Bae S, Tee C, Tee M, Tugnet N, O’Neill S, Hassett G, Goldblatt F, Ohkubo N, Miyazaki Y, Sapsford M, Tanaka Y, Navarra S, Lau C, Nikpour M, Morand E. Sustained Remission In SLE Is Infrequent On Standard Of Care: A Decade Of Insights From The Asia Pacific Lupus Collaboration [abstract]. Arthritis Rheumatol. 2025; 77 (suppl 9). https://acrabstracts.org/abstract/sustained-remission-in-sle-is-infrequent-on-standard-of-care-a-decade-of-insights-from-the-asia-pacific-lupus-collaboration/. Accessed .

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