Background/Purpose: To date, there is no generally accepted definition for remission in SLE, thus a possible goal in the treat-to-target strategy might be low disease activity. Lupus Low Disease Activity State (LLDAS) is a consensus-based definition of minimally acceptable disease activity in SLE patients (1). This definition has been initially tested for criterion validity in a multi-ethnic cohort of patients showing that it is associated with improved patient outcomes. The aims of this study are: i) to evaluate what proportion of patients fulfils the definition of LLDAS in a monocentric cohort of Caucasian SLE patients; ii) to evaluate the effect of LLDAS attainment on damage accrual over a period of 5 years.

Methods: This is a retrospective analysis of data prospectively collected in a longitudinal observational cohort of SLE patients established in our centre in 2011; patients fulfilling the 1997 ACR classification criteria who attended the last visit from January 2016 and May 2016 were enrolled in the study. Among patients regularly followed from 2012 and 2016, those with at least one visit per year and complete clinical and serological data available were included in this analysis. The definition of LLDAS was applied to each patient for each visit; organ damage was calculated with the SLICC/DI score (SDI) at study entry and at last observation.

Results: One hundred and six patients were eligible for the study (96.2% females, mean age at last visit 47.1±13, mean disease duration at last visit 17.5±9.3 years). At last observation the mean SELENA-SLEDAI score was 2.7 ±2.5; 84 patients (79.2%) were on treatment for SLE (glucocorticoids and/or immunosuppressants and/or biologics), 22 (20.7%) were off treatment or were taking only antimalarials drugs. According with all the items of the definition, at last observation LLDAS was present in 83 patients (73%); among these, 22 patients (20.8%) maintained a stable LLDAS during the 4.5 years of follow-up (LLDAS fulfilled for all visits). Twenty-seven patients (25.4%) accrued organ damage during the follow-up; in the cohort as a whole the mean increase in SDI was 0.3 (±0.6) resulting in a mean final SDI of 1.2 (±1.7). Patients who maintained LLDAS were younger (p<0.02), had a lower disease activity score at study entry (p<0.001) and were more likely GC-free at last observation (p=0.005). No differences in term of major organ involvement were present in LLDAS versus non-LLDAS patients. Patients who maintained LLDAS accrued less organ damage (ΔSLICC=0.27 vs 0.33) but this difference did not reach statistical significance.

Conclusion: In our cohort, a high percentage of patients fulfils the proposed definitions for LLDA at last visit but only a minority maintained this state for all the follow-up period. A minimally acceptable disease activity state is an achievable target in clinical practice; it is associated with a successful GC tapering and, probably, better long-term outcomes. Reference: Franklyn K, et al. Definition and initial validation of a Lupus Low Disease Activity State (LLDAS). Ann Rheum Dis. 2015; 0:1­7

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/low-disease-activity-in-systemic-lupus-erythematosus-an-achievable-goal/