A Framework for Remission in SLE: Consensus Findings From a Large International Task Force on Definitions of Remission in SLE (DORIS)

Ann Rheum Dis. 2017 Mar;76(3):554-561. doi: 10.1136/annrheumdis-2016-209519. Epub 2016 Nov 24.

Abstract

Objectives: Treat-to-target recommendations have identified 'remission' as a target in systemic lupus erythematosus (SLE), but recognise that there is no universally accepted definition for this. Therefore, we initiated a process to achieve consensus on potential definitions for remission in SLE.

Methods: An international task force of 60 specialists and patient representatives participated in preparatory exercises, a face-to-face meeting and follow-up electronic voting. The level for agreement was set at 90%.

Results: The task force agreed on eight key statements regarding remission in SLE and three principles to guide the further development of remission definitions:1. Definitions of remission will be worded as follows: remission in SLE is a durable state characterised by …………………. (reference to symptoms, signs, routine labs).2. For defining remission, a validated index must be used, for example, clinical systemic lupus erythematosus disease activity index (SLEDAI)=0, British Isles lupus assessment group (BILAG) 2004 D/E only, clinical European consensus lupus outcome measure (ECLAM)=0; with routine laboratory assessments included, and supplemented with physician's global assessment.3. Distinction is made between remission off and on therapy: remission off therapy requires the patient to be on no other treatment for SLE than maintenance antimalarials; and remission on therapy allows patients to be on stable maintenance antimalarials, low-dose corticosteroids (prednisone ≤5 mg/day), maintenance immunosuppressives and/or maintenance biologics.The task force also agreed that the most appropriate outcomes (dependent variables) for testing the prognostic value (construct validity) of potential remission definitions are: death, damage, flares and measures of health-related quality of life.

Conclusions: The work of this international task force provides a framework for testing different definitions of remission against long-term outcomes.

Keywords: Disease Activity; Outcomes research; Systemic Lupus Erythematosus.

Publication types

  • Consensus Development Conference
  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Antibodies, Antinuclear / blood
  • Antimalarials / therapeutic use
  • Complement System Proteins / metabolism
  • Consensus
  • DNA / immunology
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Lupus Erythematosus, Systemic / blood
  • Lupus Erythematosus, Systemic / drug therapy*
  • Maintenance Chemotherapy
  • Remission Induction
  • Severity of Illness Index
  • Symptom Flare Up

Substances

  • Adrenal Cortex Hormones
  • Antibodies, Antinuclear
  • Antimalarials
  • Immunosuppressive Agents
  • Complement System Proteins
  • DNA