Comparison of Attainment and Protective Effects of Lupus Low Disease Activity State In Patients With Newly Diagnosed Versus Established Systemic Lupus Erythematosus

Vera Golder; Rangi Kandane-Rathnayake; Worawit Louthrenoo; Yi-Hsing Chen; Jiacai Cho; Aisha Lateef; Laniyati Hamijoyo; Shue-Fen Luo; Yeong-Jian J Wu; Sandra V Navarra; Leonid Zamora; Zhanguo Li; Sargunan Sockalingam; Yasuhiro Katsumata; Masayoshi Harigai; Yanjie Hao; Zhuoli Zhang; B M D B Basnayake; Madelynn Chan; Jun Kikuchi; Tsutomu Takeuchi; Sang-Cheol Bae; Shereen Oon; Sean O'Neill; Fiona Goldblatt; Kristine Pek Ling Ng; Annie Law; Nicola Tugnet; Sunil Kumar; Cherica Tee; Michael Tee; Naoaki Ohkubo; Yoshiya Tanaka; Chak Sing Lau; Mandana Nikpour; Alberta Hoi; Eric F Morand; Asia Pacific Lupus Collaboration

doi:10.3899/jrheum.2023-0900

Comparison of Attainment and Protective Effects of Lupus Low Disease Activity State In Patients With Newly Diagnosed Versus Established Systemic Lupus Erythematosus

J Rheumatol. 2024 May 1:jrheum.2023-0900. doi: 10.3899/jrheum.2023-0900. Online ahead of print.

Authors

Vera Golder¹, Rangi Kandane-Rathnayake², Worawit Louthrenoo³, Yi-Hsing Chen⁴, Jiacai Cho⁵, Aisha Lateef⁶, Laniyati Hamijoyo⁷, Shue-Fen Luo⁸, Yeong-Jian J Wu⁹, Sandra V Navarra¹⁰, Leonid Zamora¹¹, Zhanguo Li¹², Sargunan Sockalingam¹³, Yasuhiro Katsumata¹⁴, Masayoshi Harigai¹⁵, Yanjie Hao¹⁶, Zhuoli Zhang¹⁷, B M D B Basnayake¹⁸, Madelynn Chan¹⁹, Jun Kikuchi²⁰, Tsutomu Takeuchi²¹, Sang-Cheol Bae²², Shereen Oon²³, Sean O'Neill²⁴, Fiona Goldblatt²⁵, Kristine Pek Ling Ng²⁶, Annie Law²⁷, Nicola Tugnet²⁸, Sunil Kumar²⁹, Cherica Tee³⁰, Michael Tee³¹, Naoaki Ohkubo³², Yoshiya Tanaka³³, Chak Sing Lau³⁴, Mandana Nikpour³⁵, Alberta Hoi³⁶, Eric F Morand³⁷; Asia Pacific Lupus Collaboration

Affiliations

¹ V. Golder, MBBS, PhD, Monash University, Melbourne, Australia.
² R. Kandane-Rathnayake, PhD, Monash University, Melbourne, Australia.
³ W. Louthrenoo, MD, Faculty of Medicine, Chiang Mai University, Chang Mai, Thailand.
⁴ Y.H. Chen, MD, Taichung Veterans General Hospital, Taichung, Taiwan.
⁵ J. Cho, MBBS, National University Hospital, Singapore.
⁶ A. Lateef, MBBS, National University Hospital, Singapore.
⁷ L. Hamijoyo, MD, University of Padjadjaran, Bandung, Indonesia.
⁸ S.F. Luo, MD, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
⁹ Y.J.J. Wu, MD, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
¹⁰ S.V. Navarra, MD, University of Santo Tomas Hospital, Manila, Philippines.
¹¹ L. Zamora, MD, University of Santo Tomas Hospital, Manila, Philippines.
¹² Z. Li, MD, People's Hospital Peking University Health Sciences Centre, Beijing, China.
¹³ S. Sockalingam, MBBS, University of Malaya, Kuala Lumpur, Malaysia.
¹⁴ Y. Katsumata, MD, Tokyo Women's Medical University, Tokyo, Japan.
¹⁵ M. Harigai, MD, Tokyo Women's Medical University, Tokyo, Japan.
¹⁶ Y. Hao, MD, Peking University First Hospital, Beijing, China.
¹⁷ Z. Zhang, MD, Peking University First Hospital, Beijing, China.
¹⁸ B.M.D.B. Basnayake, MBBS, Teaching Hospital, Kandy, Sri Lanka.
¹⁹ M. Chan, MBBS, Tan Tock Seng Hospital, Singapore.
²⁰ J. Kikuchi, MD, Keio University, Tokyo, Japan.
²¹ T. Takeuchi, MD, Keio University, Tokyo, and Saitama Medical University, Saitama, Japan.
²² S.C. Bae, MD, Hanyang University Hospital for Rheumatic Diseases, Hanyang University Institute for Rheumatology Research, and Hanyang University Institute of Bioscience and Biotechnology, Seoul, South Korea.
²³ S. Oon, MBBS, PhD, Department of Medicine, University of Melbourne at St Vincent's Hospital, Fitzroy, Australia.
²⁴ S. O'Neill, BMed, PhD, University of New South Wales and Ingham Institute of Applied Medical Research, Liverpool, Australia.
²⁵ F. Goldblatt, MBBS, PhD, Royal Adelaide Hospital and Flinders Medical Centre, Bedford Park, Australia.
²⁶ K.P.L. Ng, MBBS, Waitemata District Health Board, Auckland, New Zealand.
²⁷ A. Law, MBBS, Singapore General Hospital, Singapore.
²⁸ N. Tugnet, MBCHB, Auckland District Health Board, Auckland, New Zealand.
²⁹ S. Kumar, MBBS, Middlemore Hospital, Auckland, New Zealand.
³⁰ C. Tee, MD, University of the Philippines, Quezon City, Philippines.
³¹ M. Tee, MD, University of the Philippines, Quezon City, Philippines.
³² N. Ohkubo, MD, University of Occupational and Environmental Health, Kitakyushu, Japan.
³³ Y. Tanaka, MD, University of Occupational and Environmental Health, Kitakyushu, Japan.
³⁴ C.S. Lau, MD, University of Hong Kong, Hong Kong.
³⁵ M. Nikpour, MBBS, PhD, University of Melbourne at St Vincent's Hospital, Fitzroy, Australia.
³⁶ A. Hoi, MBBS, PhD, Monash University, Melbourne, Australia.
³⁷ E.F. Morand, MBBS, PhD, Monash University, Melbourne, Australia.

PMID: 38490668
DOI: 10.3899/jrheum.2023-0900

Abstract

Objective: To assess whether Lupus Low Disease Activity State (LLDAS) attainment is associated with favorable outcomes in patients with recent onset systemic lupus erythematosus (SLE).

Methods: Data from a 13-country longitudinal SLE cohort were collected prospectively between 2013 and 2020. An inception cohort was defined based on disease duration < 1 year at enrollment. Patient characteristics between inception and noninception cohorts were compared. Survival analyses were performed to examine the association between LLDAS attainment and damage accrual and flare.

Results: Of the total 4106 patients, 680 (16.6%) were recruited within 1 year of SLE diagnosis (inception cohort). Compared to the noninception cohort, inception cohort patients were significantly younger, had higher disease activity, and used more glucocorticoids, but had less organ damage at enrollment. Significantly fewer inception cohort patients were in LLDAS at enrollment than the noninception cohort (29.6% vs 52.3%, P < 0.001), but three-quarters of both groups achieved LLDAS at least once during follow-up. Limiting analysis only to patients not in LLDAS at enrollment, inception cohort patients were 60% more likely to attain LLDAS (hazard ratio 1.37, 95% CI 1.16-1.61, P < 0.001) than noninception cohort patients and attained LLDAS significantly faster. LLDAS attainment was significantly protective against flare in both the inception and noninception cohorts. A total of 88 (13.6%) inception cohort patients accrued organ damage during a median 2.2 years of follow-up.

Conclusion: LLDAS attainment is protective from flare in recent onset SLE. Significant protection from damage accrual was not observed because of low rates of damage accrual in the first years after SLE diagnosis. (ClinicalTrials.gov: NCT03138941).

Associated data

ClinicalTrials.gov/NCT03138941