Prevalence, Determinants and Outcomes of Target Attainment in SLE Patients with Clinically Active Disease in a Large Multinational Prospective Lupus Cohort

Yanjie Hao¹, Dylan Hansen², Rangi Kandane-Rathnayake³, Worawit Louthrenoo⁴, Yi-Hsing Chen⁵, Jiacai Cho⁶, Aisha Lateef⁶, Laniyati Hamijoyo⁷, Shue-Fen Luo⁸, Yeong-Jian J Wu⁹, Sandra Navarra¹⁰, Leonid Zamora¹⁰, Zhanguo Li¹¹, Sargunan Sockalingam¹², Yasuhiro Katsumata¹³, Masayoshi Harigai¹³, Zhuoli Zhang¹⁴, Madelynn Chan¹⁵, Jun Kikuchi¹⁶, Tsutomu Takeuchi¹⁷, Sang-Cheol Bae¹⁸, Fiona Goldblatt¹⁹, Sean O’Neill²⁰, Kristine Ng²¹, Annie Law²², BMDB Basnayake²³, Nicola Tugnet²⁴, Sunil Kumar²⁵, Cherica Tee²⁶, Michael Tee²⁶, Yoshiya Tanaka²⁷, Chak Sing Lau²⁸, Vera Golder³, Alberta Hoi²⁹, Eric Morand³⁰, Shereen Oon³¹ and Mandana Nikpour³², ¹The University of Melbourne Department of Medicine at St Vincents Hospital Melbourne, Melbourne, Australia, ²Department of Rheumatology, St Vincent’s Hospital Melbourne, Fitzroy, Australia, ³Monash University, Department of Medicine, Sub-faculty of Clinical and Molecular Medicine, Clayton, Australia, ⁴Chiang Mai University Hospital, Department of Internal Medicine, Faculty of Medicine, Chiang Mai, Thailand, ⁵Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan, ⁶National University Hospital, Rheumatology Division, Department of Medicine, Singapore, Singapore, ⁷Padjadjaran University/Hasan Sadikin General Hospital, Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Bandung, Indonesia, ⁸Chang Gung University, Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ⁹Chang Gung University, Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Keelung, Taiwan, ¹⁰University of Santo Tomas Hospital, Joint and Bone Center, Manila, Philippines, ¹¹Peking University Health Science Center, Department of Rheumatology and Immunology, People's Hospital, Beijing, China, ¹²University of Malaya, Department of Medicine, Faculty of Medicine Building, Kuala Lumpur, Malaysia, ¹³Tokyo Women's Medical University, Division of Rheumatology, Department of Internal Medicine, Tokyo, Japan, ¹⁴Peking University First Hospital, Rheumatology and Immunology Department, Beijing, China, ¹⁵Tan Tock Seng Hospital, Department of Rheumatology, Allergy & Immunology, Singapore, Singapore, ¹⁶Keio University School of Medicine, Tokyo, Japan, ¹⁷Keio University School of Medicine and Saitama Medical University, Tokyo, Japan, ¹⁸Hanyang University Hospital for Rheumatic Diseases and Hanyang University Institute for Rheumatology Research, Department of Rheumatology, Seoul, South Korea, ¹⁹Royal Adelaide Hospital and Flinders Medical Centre, Adelaide, Australia, ²⁰Department of Medicine, University of New South Wales, Kensington, Australia, ²¹Waitemata DHB, Auckland, New Zealand, ²²Singapore General Hospital; Duke-NUS Medical School, Singapore, Singapore, ²³Division of Nephrology, Teaching Hospital Kandy, Adelaide, Australia, ²⁴Auckland District Health Board, Auckland, New Zealand, ²⁵Middlemore Hospital, Auckland, New Zealand, ²⁶University of the Philippines, Manila, Philippines, ²⁷University of Occupational and Environmental Health, Kitakyushu, Japan, ²⁸University of Hong Kong, Division of Rheumatology & Clinical Immunology, Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong, ²⁹Monash University, Department of Medicine, Sub-faculty of Clinical and Molecular Medicine, Melbourne, Australia, ³⁰Monash University, Centre for Inflammatory Diseases, Melbourne, Australia, ³¹University of Melbourne at St Vincent’s Hospital, Departments of Rheumatology and Medicine, Fitzroy, Australia, ³²The University of Melbourne at St. Vincent’s Hospital Melbourne, Departments of Medicine and Rheumatology, Melbourne, Australia

Meeting: ACR Convergence 2023

Keywords: Damage Index, Disease Activity, Systemic lupus erythematosus (SLE)

Session Information

Date: Tuesday, November 14, 2023

Title: Abstracts: SLE – Diagnosis, Manifestations, & Outcomes III: Disease Activity

Session Type: Abstract Session

Session Time: 4:00PM-5:30PM

Background/Purpose: There is increasing interest in adopting the principle of treating to target (T2T) in systemic lupus erythematosus (SLE). Remission and low disease activity states have been demonstrated to have protective associations with adverse outcomes such as flare, damage accrual and mortality. However, knowledge gaps remain in relation to the timing and impact of target attainment. In this study, we aimed to identify (i) the proportion of patients achieving the lupus low disease activity state (LLDAS) and the definition of remission in SLE (DORIS-remission) subsequent to a visit with clinically active disease, (ii) time to attainment of LLDAS and DORIS-remission, (iii) determinants of attaining these targets, and (iv) frequency and time to flare and damage accrual following target attainment.

Methods: Patients in the Asia Pacific Lupus Collaboration (APLC) cohort, followed between 2013 and 2020 who had any clinical disease activity according to the clinical domains of SLEDAI-2K and did not fulfill LLDAS or DORIS-remission were followed from their first time fulfilling these criteria. SELENA-SLEDAI flare index and the SLICC/ACR Damage Index were used to assess flare and damage accrual, respectively. We used Multivariable Cox regression models to analyse factors associated with attainment of LLDAS and DORIS-remission. Generalized estimating equation (GEE) models were used to identify factors associated with flare after attainment of target.

Results: 2852 patients (92.4% female) were followed for a median of 3.3 (1.1-5.7) years. The mean (standard deviations) SLEDAI and PGA at the first visit with clinical activity were 7.0±4.3 and 0.9±0.7, respectively. 1858 (65.2%) of the patients achieved LLDAS, with median (interquartile ranges) time to first attainment of LLDAS being 0.5 (0.3-1.2) years (Figure 1). The proportion and median time to first attainment of DORIS-remission were 49.3% and 0.7 (0.4-1.6) years, respectively. Multivariable Cox model showed that nephritis, positive anti-dsDNA and low complement were associated with a longer time to attainment of LLDAS and DORIS-remission, and in addition non-Asian ethnicity was associated with a longer time taken to attain DORIS-remission (Table 1). After the first attainment of LLDAS, 887/1852 (47.9%) of patients experienced flare(s) with a median time to first flare of 0.7 (0.3-1.4) years. 679/1405 (48.3%) patients had flare(s) after the first attainment of DORIS-remission within a median time of 0.8 (0.3-1.6) years (Figure 1). In multivariable GEE model, factors associated with flare post attainment of LLDAS included tapering of corticosteroids and immunosuppressants (Table 2). 110/960 (11.5%) and 77/750 (10.2%) patients had damage accrual within 24 months of first attainment of LLDAS and DORIS-remission, respectively (Figure 1).

Conclusion: In patients with clinically active disease, LLDAS and DORIS-remission are both achievable goals. However, flares still occur in almost 50% of patients, and 10-11.5% of patients still accrue damage over two years following LLDAS or DORIS-remission attainment, suggesting that further research is needed to inform monitoring and treatment adjustment in SLE patients to maintain states associated with optimal outcomes.

Flare-free and damage accrual-free survival after first attainment of LLDAS or DORIS-remission

Disclosures: Y. Hao: None; D. Hansen: None; R. Kandane-Rathnayake: None; W. Louthrenoo: None; Y. Chen: None; J. Cho: None; A. Lateef: None; L. Hamijoyo: None; S. Luo: None; Y. Wu: None; S. Navarra: Astellas, 6, AstraZeneca, 6, Biogen, 2, Boehringer-Ingelheim, 2, GSK, 6, Novartis, 6, Pfizer, 6; L. Zamora: None; Z. Li: Abbott, 2, 9, Abbvie, 2, 9, BMS, 2, 9, Celgene, 2, 9, Eli Lilly, 2, 9, GSK, 2, 9, Janssen, 2, 9, MSD, 2, 9, Novartis, 2, 9, Pfizer, 2, 9, Roche, 2, 9, UCB Pharma, 2, 9; S. Sockalingam: AstraZeneca, 2, 12, Other - for attending meetings and/or travel, Pfizer, 2, 12, Other - for attending meetings and/or travel, ZP Therapeutics, 2; Y. Katsumata: Asahi Kasei Pharma, 6, Astella, 6, AstraZeneca, 6, Chugai, 6, GlaxoSmithKlein(GSK), 6, Janssen, 6, Mitsubishi Tanabe Pharma Corporation, 6, Pfizer, 6; M. Harigai: Astellas Pharma, 6, AstraZeneca, 6, GlaxoSmithKlein(GSK), 6, 12, Post marketing surveillence, Novartis, 5; Z. Zhang: None; M. Chan: None; J. Kikuchi: None; T. Takeuchi: AbbVie, 2, 5, 6, AYUMI, 5, Bristol-Myers Squibb, 6, Chugai, 2, 5, 6, Daiichi Sankyo, 5, Eisai, 5, 6, Eli Lilly Japan, 2, 6, Gilead, 2, 6, Janssen, 6, Mitsubishi-Tanabe, 2, 5, 6, ONO, 5, Pfizer Japan, 6, Taiho, 2; S. Bae: None; F. Goldblatt: None; S. O’Neill: None; K. Ng: AbbVie/Abbott, 1; A. Law: None; B. Basnayake: None; N. Tugnet: None; S. Kumar: None; C. Tee: None; M. Tee: None; Y. Tanaka: AbbVie, 6, AstraZeneca, 6, BMS, 6, Boehringer-Ingelheim, 6, Chugai, 5, 6, Eisai, 5, 6, Eli Lilly, 6, Gilead, 6, GSK, 6, Mitsubishi-Tanabe, 5, Pfizer, 6, Taiho, 6, Taisho, 5, 6; C. Lau: AstraZeneca, 6, 12, external expert for SLE sterring committee 11.2022; V. Golder: None; A. Hoi: Abbvie, 6, AstraZeneca, 5, Australian Rheumatology Association, 4, Eli Lilly, 6, EUSA Pharma (UK) Limited, 2, Limbic, 6, Moose Republic, 6, Novartis, 6; E. Morand: AbbVie, 2, 5, Amgen, 5, AstraZeneca, 2, 5, 6, Biogen, 2, 5, Bristol Myers Squibb, 2, 5, Eli Lilly, 2, 5, EMD Serono, 2, 5, Galapagos, 2, Genentech, 2, 5, GlaxoSmithKline, 2, 5, IgM, 2, Janssen, 2, 5, Novartis, 2, Servier, 2, Takeda, 2, UCB, 5; S. Oon: None; M. Nikpour: AstraZeneca, 2, 6, Boehringer-Ingelheim, 2, 6, GSK, 2, 6, Janssen Pharmaceuticals, 2, 5, 6.

To cite this abstract in AMA style:

Hao Y, Hansen D, Kandane-Rathnayake R, Louthrenoo W, Chen Y, Cho J, Lateef A, Hamijoyo L, Luo S, Wu Y, Navarra S, Zamora L, Li Z, Sockalingam S, Katsumata Y, Harigai M, Zhang Z, Chan M, Kikuchi J, Takeuchi T, Bae S, Goldblatt F, O’Neill S, Ng K, Law A, Basnayake B, Tugnet N, Kumar S, Tee C, Tee M, Tanaka Y, Lau C, Golder V, Hoi A, Morand E, Oon S, Nikpour M. Prevalence, Determinants and Outcomes of Target Attainment in SLE Patients with Clinically Active Disease in a Large Multinational Prospective Lupus Cohort [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/prevalence-determinants-and-outcomes-of-target-attainment-in-sle-patients-with-clinically-active-disease-in-a-large-multinational-prospective-lupus-cohort/. Accessed .

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