Proposal for Defining Moderate and Severe Activity States in Systemic Lupus Erythematosus. Impact on Flares and Other Outcomes

Ivonne Lourdes Mamani Velarde¹, Iñigo Rúa-Figueroa², Sara García Pérez¹, Irene Altabás González³, CORAL Mourino Rodriguez⁴, Norman Jiménez⁵, JULIA MARTINEZ BARRIO⁶, Maria Galindo-Izquierdo⁷, Jaime Calvo- Alén⁸, Celia Eurasquin⁹, Belen Serrano Benavente¹⁰, Esther Uriarte Isacelaya¹¹, Eva Tomero Muriel¹², Mercedes Freire González¹³, Ricardo Blanco¹⁴, Eva Salgado-Pérez¹⁵, Paloma Vela¹⁶, Antonio Fernandez-Nebro¹⁷, Alejandro Olivé-Marqués¹⁸, Clara Sanguesa Gomez¹⁹, Javier Narvaez²⁰, Raúl Menor-Almagro²¹, Jose Rosas²², José Ángel Hernández Beriain²³, JAVIER MANERO²⁴, Elena Aurrecoechea Aguinaga²⁵, Oihane Ibarguengoitia-Barrena²⁶, Carlos Montilla-Morales²⁷, Gema Bonilla²⁸, Vicente Torrente-Segarra²⁹, Ana Paula Cacheda³⁰, Maria J. García-Villanueva³¹, Clara Moriano Morales³², Concepción Fito Manteca³³, Nuria Lozano Rivas³⁴, Cristina Bohórquez³⁵ and Jose-Maria Pego-Reigosa³⁶, ¹University Hospital of Vigo, Department of Rheumatology. IRIDIS Group (Investigation in Rheumatology and Immune-Diseases), Galicia Sur Health Research Institute (IISGS), Vigo, Spain, ²Rheumatology, Hospital de Gran Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain, ³Department of Rheumatology, University Hospital of Vigo. IRIDIS Group (Investigation in Rheumatology and Immune-Diseases), Vigo, Spain, ⁴Complejo Hospitalario Universitario de Vigo. IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, Vigo, Spain, ⁵IIRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute., Vigo, Spain, ⁶Rheumatology, Gregorio Marañon University Hospital, Madrid, Spain, ⁷Rheumatology, University Hospital of 12 de Octubre, Madrid, Spain, ⁸Rheumatology, Bioaraba Research Unit, Hospital Universitario Araba, Vitoria, Spain, ⁹Department of Rheumatology, Doctor Negrín University Hospital, Las Palmas de Gran Canaria, Spain, ¹⁰Rheumatology Department Hospital Gregorio Marañón, Madrid, Spain, ¹¹Rheumatology, University Hospital of Donosti, San Sebastián, Spain, ¹²Rheumatology, Hospital La Princesa, Madrid, Spain, ¹³Rheumatology department, Complexo Hospitalario Universitario A Coruña (CHUAC). Instituto de Investigación Biomédica A Coruña (INIBIC), A Coruña, Spain, ¹⁴Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain, ¹⁵Department of Rheumatology, University Hospital of Ourense, Ourense, Spain, ¹⁶Department of Rheumatology, University Hospital of Alicante, Alicante, Spain, ¹⁷Hospital Regional Universitario de Málaga, Malaga, Spain, ¹⁸Department of Rheumatology, Hospital Germans Trias i Pujol, Badalona, Spain, ¹⁹Severo Ochoa Hospital, Madrid, Spain, ²⁰Hospital Universitario de Bellvitge, Barcelona, Spain, ²¹Rheumatology, Hospital Jerez, Puerto De Santa María, Spain, ²²Department of Rheumatology, Hospital Villajoyosa, Alicante, Spain, ²³Rheumatology, Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain, ²⁴Department of Rheumatology, Hospital Universitario Miguel Servet, Zaragoza, Spain, ²⁵Department of Rheumatology, Hospital Sierrallana, Torrelavega, Spain, ²⁶Galdakao-Usansolo University Hospital, Bilbao, Spain, ²⁷Rheumatology, University Hospital of Salamanca, Salamanca, Spain, ²⁸Department of Rheumatology, Hospital Clínico Universitario La Paz, Madrid, Spain, ²⁹Department of Rheumatology, Hospital de Sant Joan Despí Moises Broggi,, Sant Joan Despí, Spain, ³⁰Department of Rheumatology, Hospital Son Llatzer, Palma de Mallorca, Spain, ³¹Hospital Ramón y Cajal, Madrid, Spain, ³²Rheumatology, Hospital Universitario de León, León, Spain, ³³Complejo Universitario de Navarra, Pamplona, Spain, ³⁴Department of Rheumatology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain, ³⁵Department of Rheumatology, University Hospital Príncipe de Asturias, Alcalá de Henares, Spain, ³⁶Rheumatology, Hospital do Meixoeiro, Vigo, Spain

Meeting: ACR Convergence 2023

Keywords: classification criteria, Disease Activity, Systemic lupus erythematosus (SLE)

Session Information

Date: Tuesday, November 14, 2023

Title: (2257–2325) SLE – Diagnosis, Manifestations, & Outcomes Poster III

Session Type: Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: In systemic lupus erythematosus (SLE), there is no definition of states of moderate and severe SLE activity. How these states may influence different disease outcomes is unknown.
To propose a definition for states of moderate and severe activity in SLE and using the largest Spanish national cohort of SLE patients, to describe the prevalence of both states of activity and to analyze the impact of this classification on flare-ups, achieving low disease activity state (LLDAS), hospital admissions, health-related quality of life (HRQoL), damage accrual and mortality.

Methods: We propose definitions for states of moderate and severe activity in SLE (Table 1). To analyze the impact of this classification, available data from the prospective phaseof the Spanish Society of Rheumatology SLE Registry (RELESSER-PROS) were used, with 5 annual visits (V1-V5) over 4 years. Patients were required to have at least 3 consecutive visits. At each visit, the number of flares and their severity (according to the SELENA Flare Index), visits in LLDAS, hospital admissions, HRQoL according to the Lupus Impact Tracker (LIT), damage accrual (using the SLICC/ACR Damage Index [SDI]) and mortality was collected. T-test was used for group comparisons.

Results: A total of 1463 patients (90% women) were included, with a mean age (±SD) of 56 (±13.5) years. The mean disease duration of SLE (±SD) at V1 was 14 (±8.5) years. Patients had a mean (±SD) of 4.2 (±1.2) visits and a mean (±SD) follow-up of 2.5 (±0.7) years. Moderate activity was shown by 54 patients (3.7%) at V1, 20 patients (1.4%) at V2, 27 patients (1.8%) at V3, 5 patients (0.3%) at V4, and 11 patients (0.8%) at V5. On the other hand, 40 patients (2.7%) at V1, 15 patients (1.0%) at V2, 13 patients (0.9%) at V3, 6 patients (0.4%) at V4 and 3 patients (0.2%) at V5 showed severe activity. Patients who presented both moderate and severe activity in at least 1 of the 5 visits had a significantly higher mean total number of flares over the 4-year follow-up period (V1-V5)than those who did not (p< 0.001). These same results occur in the case of severe flares. Regarding mild-moderate flares, patients with moderate and severe activity in at least 1 visit, had a higher mean number than patients without these activities, being statistically significant for moderate activity. More detailed information about flares can be seen in Table 2. On the other hand, patients who presented both moderate and severe activity in at least 1 of the 5 visits had significantly less number of visits in LLDAS, higher number of hospital admissions, worse HRQoL and greater damage accrual in the period V1-V5 than those who did not (p< 0.001 for all comparisons). Patients with severe activity in ≥1 visit had higher mortality (p=n.s.) (Table 3).

Conclusion: Patients who were in a state of moderate and/or severe activity at least on 1 occasion had worse outcomes at the end of follow-up in terms of number/severity of flares, hospital admissions, deterioration in HRQoL and damage accrual. These results emphasize the importance of setting achievable objectives in the Treat to Target (T2T) strategy for the treatment of SLE.

Table 1. Criteria and proposals for the definition of states of moderate and severe activity in SLE.

Table 2. Mean number of flares (total, severe and mild-moderate) over the follow-up period (4 years) according to the activity status.

Table 3. Comparative results in LLDAS status, admissions, HRQoL, damage accrual and mortality over the follow-up period (4 years) in patients
who have ever been in a situation of moderate or severe activity compared to those who have not.

Disclosures: I. Mamani Velarde: None; I. Rúa-Figueroa: AstraZeneca, 5, GSK, 1, 6; S. García Pérez: None; I. Altabás González: None; C. Mourino Rodriguez: None; N. Jiménez: None; J. MARTINEZ BARRIO: None; M. Galindo-Izquierdo: None; J. Calvo- Alén: AbbVie, 2, AstraZeneca, 2, Biogen, 6, BMS, 5, Galapagos, 6, GSK, 2, 6, Lilly, 2, 6, Novartis, 2, 6, Roche, 5, Sanofi, 2; C. Eurasquin: None; B. Serrano Benavente: None; E. Uriarte Isacelaya: None; E. Tomero Muriel: None; M. Freire González: None; R. Blanco: AbbVie, 5, 6, Amgen, 6, AstraZeneca, 2, BMS, 6, Eli Lilly, 6, Galapagos, 2, 6, Janssen, 2, 6, MSD, 6, Novartis, 2, 6, Pfizer, 2, 6, Roche, 5, 6, Sanofi, 6; E. Salgado-Pérez: None; P. Vela: None; A. Fernandez-Nebro: None; A. Olivé-Marqués: None; C. Sanguesa Gomez: None; J. Narvaez: None; R. Menor-Almagro: None; J. Rosas: None; J. Hernández Beriain: None; J. MANERO: None; E. Aurrecoechea Aguinaga: None; O. Ibarguengoitia-Barrena: None; C. Montilla-Morales: None; G. Bonilla: None; V. Torrente-Segarra: None; A. Cacheda: None; M. García-Villanueva: AstraZeneca, 6, GSK, 6, Otsuka, 1; C. Moriano Morales: None; C. Fito Manteca: None; N. Lozano Rivas: None; C. Bohórquez: None; J. Pego-Reigosa: None.

To cite this abstract in AMA style:

Mamani Velarde I, Rúa-Figueroa I, García Pérez S, Altabás González I, Mourino Rodriguez C, Jiménez N, MARTINEZ BARRIO J, Galindo-Izquierdo M, Calvo- Alén J, Eurasquin C, Serrano Benavente B, Uriarte Isacelaya E, Tomero Muriel E, Freire González M, Blanco R, Salgado-Pérez E, Vela P, Fernandez-Nebro A, Olivé-Marqués A, Sanguesa Gomez C, Narvaez J, Menor-Almagro R, Rosas J, Hernández Beriain J, MANERO J, Aurrecoechea Aguinaga E, Ibarguengoitia-Barrena O, Montilla-Morales C, Bonilla G, Torrente-Segarra V, Cacheda A, García-Villanueva M, Moriano Morales C, Fito Manteca C, Lozano Rivas N, Bohórquez C, Pego-Reigosa J. Proposal for Defining Moderate and Severe Activity States in Systemic Lupus Erythematosus. Impact on Flares and Other Outcomes [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/proposal-for-defining-moderate-and-severe-activity-states-in-systemic-lupus-erythematosus-impact-on-flares-and-other-outcomes/. Accessed .

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