Abstract
Original language | English |
---|---|
Article number | 222487 |
Pages (from-to) | 1541-1548 |
Number of pages | 8 |
Journal | Annals of the rheumatic diseases |
Volume | 81 |
Issue number | 11 |
Early online date | 2022 |
DOIs | |
Publication status | Published - 9 Aug 2022 |
Keywords
- epidemiology
- outcome assessment, health care
- systemic lupus erythematosus
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In: Annals of the rheumatic diseases, Vol. 81, No. 11, 222487, 09.08.2022, p. 1541-1548.
Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Remission and low disease activity (LDA) prevent damage accrual in patients with systemic lupus erythematosus
T2 - Results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort
AU - Ugarte-Gil, Manuel Francisco
AU - Hanly, John
AU - Urowitz, Murray
AU - Gordon, Caroline
AU - Bae, Sang-Cheol
AU - Romero-Diaz, Juanita
AU - Sanchez-Guerrero, Jorge
AU - Bernatsky, Sasha
AU - Clarke, Ann Elaine
AU - Wallace, Daniel J.
AU - Isenberg, David Alan
AU - Rahman, Anisur
AU - Merrill, Joan T.
AU - Fortin, Paul R.
AU - Gladman, Dafna D.
AU - Bruce, Ian N.
AU - Petri, Michelle
AU - Ginzler, Ellen M.
AU - Dooley, Mary Anne
AU - Ramsey-Goldman, Rosalind
AU - Manzi, Susan
AU - Jönsen, Andreas
AU - van Vollenhoven, Ronald F.
AU - Aranow, Cynthia
AU - MacKay, Meggan
AU - Ruiz-Irastorza, Guillermo
AU - Lim, Sam
AU - Inanc, Murat
AU - Kalunian, Ken
AU - Jacobsen, S. ren
AU - Peschken, Christine
AU - Kamen, Diane L.
AU - Askanase, Anca
AU - Pons-Estel, Bernardo A.
AU - Alarcón, Graciela S.
N1 - Funding Information: These analyses were supported by a grant from the Universidad Científica del Sur. Other sources of funding supported activities at individual Systemic Lupus International Collaborating Clinics sites: CG is supported by Lupus UK, Sandwell and West Birmingham Hospitals NHS Trust and the National Institute for Health Research (NIHR)/Wellcome Trust Birmingham Clinical Research Facility. The views expressed are those of the authors(s) and not necessarily those of the NHS, the NIHR or the Department of Health. S-CB’s work was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2021R1A6A1A03038899). AEC holds The Arthritis Society Chair in Rheumatic Diseases at the University of Calgary. The Montreal General Hospital Lupus Clinic is partially supported by the Singer Family Fund for Lupus Research. PRF holds a tier 1 Canada Research Chair on Systemic Autoimmune Rheumatic Diseases at Université Laval. DAI and AR are supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. INB is a National Institute for Health Research (NIHR) senior investigator and is supported by Arthritis Research UK, the NIHR Manchester Biomedical Centre and the NIHR/Wellcome Trust Manchester Clinical Research Facility. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. The Hopkins Lupus Cohort is supported by NIH (grant AR43727 and 69572). RR-G’s work was supported by NIH (grants 5UL1TR001422-02, formerly 8UL1TR000150 and UL-1RR-025741, K24-AR-02318, and P60AR064464, formerly P60-AR-48098). MAD’s work was supported by NIH grant RR00046. GR-I is supported by the Department of Education, Universities and Research of the Basque Government. SJ is supported by the Danish Rheumatism Association (A3865) and the Novo Nordisk Foundation (A05990). SL’s work was supported, in part, by the Centers for Disease Control and Prevention (grant U01DP005119). Funding Information: All the following relationships are outside the submitted work. MF-UG: research support from Janssen and Pfizer. CG: consulting fees from the AbbVie, Amgen, AstraZeneca, Centers for Disease Control, Morton Grove Pharmaceutical (MGP), Sanofi and UCB. AEC: consulting fees from AstraZeneca, Bristol Myers Squibb, Exagen Diagnostics and GlaxoSmithKline. DAI: consulting fees from Amgen, Merck Serono, AstraZeneca and Eli Lilly (the honoraria are passed onto a local arthritis charity). AR: consulting fees from Lilly. PRF: participation on advisory boards from AbbVie, AstraZeneca and Lilly. MAK: consulting fees from GSK. MI: consulting fees from AbbVie, UCB, Novartis, Janssen and Lilly. Funding Information: These analyses were supported by a grant from the Universidad Científica del Sur. Other sources of funding supported activities at individual Systemic Lupus International Collaborating Clinics sites: CG is supported by Lupus UK, Sandwell and West Birmingham Hospitals NHS Trust and the National Institute for Health Research (NIHR)/Wellcome Trust Birmingham Clinical Research Facility. The views expressed are those of the authors(s) and not necessarily those of the NHS, the NIHR or the Department of Health. S-CB’s work was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2021R1A6A1A03038899). AEC holds The Arthritis Society Chair in Rheumatic Diseases at the University of Calgary. The Montreal General Hospital Lupus Clinic is partially supported by the Singer Family Fund for Lupus Research. PRF holds a tier 1 Canada Research Chair on Systemic Autoimmune Rheumatic Diseases at Universite Laval. DAI and AR are supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. INB is a National Institute for Health Research (NIHR) senior investigator and is supported by Arthritis Research UK, the NIHR Manchester Biomedical Centre and the NIHR/Wellcome Trust Manchester Clinical Research Facility. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. The Hopkins Lupus Cohort is supported by NIH (grant AR43727 and 69572). RR-G’s work was supported by NIH (grants 5UL1TR001422-02, formerly 8UL1TR000150 and UL-1RR- 025741, K24-AR- 02318, and P60AR064464, formerly P60-AR- 48098). MAD’s work was supported by NIH grant RR00046. GR-I is supported by the Department of Education, Universities and Research of the Basque Government. SJ is supported by the Danish Rheumatism Association (A3865) and the Novo Nordisk Foundation (A05990). SL’s work was supported, in part, by the Centers for Disease Control and Prevention (grant U01DP005119) Publisher Copyright: © 2022 BMJ Publishing Group. All rights reserved.
PY - 2022/8/9
Y1 - 2022/8/9
N2 - Objective: To determine the independent impact of different definitions of remission and low disease activity (LDA) on damage accrual. Methods: Patients with ≥2 annual assessments from a longitudinal multinational inception lupus cohort were studied. Five mutually exclusive disease activity states were defined: remission off-treatment: clinical Systemic Lupus Erythematosus Disease Activity Index (cSLEDAI)-2K=0, without prednisone or immunosuppressants; remission on-treatment: cSLEDAI-2K score=0, prednisone ≤5 mg/day and/or maintenance immunosuppressants; low disease activity Toronto cohort (LDA-TC): cSLEDAI-2K score of ≤2, without prednisone or immunosuppressants; modified lupus low disease activity (mLLDAS): Systemic Lupus Erythematosus Disease Activity Index-2K score of 4 with no activity in major organ/systems, no new disease activity, prednisone ≤7.5 mg/day and/or maintenance immunosuppressants; active: all remaining visits. Only the most stringent definition was used per visit. Antimalarials were allowed in all. The proportion of time that patients were in a specific state at each visit since cohort entry was determined. Damage accrual was ascertained with the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). Univariable and multivariable generalised estimated equation negative binomial regression models were used. Time-dependent covariates were determined at the same annual visit as the disease activity state but the SDI at the subsequent visit. Results: There were 1652 patients, 1464 (88.6%) female, mean age at diagnosis 34.2 (SD 13.4) years and mean follow-up time of 7.7 (SD 4.8) years. Being in remission off-treatment, remission on-treatment, LDA-TC and mLLDAS (per 25% increase) were each associated with a lower probability of damage accrual (remission off-treatment: incidence rate ratio (IRR)=0.75, 95% CI 0.70 to 0.81; remission on-treatment: IRR=0.68, 95% CI 0.62 to 0.75; LDA: IRR=0.79, 95% CI 0.68 to 0.92; and mLLDAS: IRR=0.76, 95% CI 0.65 to 0.89)). Conclusions: Remission on-treatment and off-treatment, LDA-TC and mLLDAS were associated with less damage accrual, even adjusting for possible confounders and effect modifiers.
AB - Objective: To determine the independent impact of different definitions of remission and low disease activity (LDA) on damage accrual. Methods: Patients with ≥2 annual assessments from a longitudinal multinational inception lupus cohort were studied. Five mutually exclusive disease activity states were defined: remission off-treatment: clinical Systemic Lupus Erythematosus Disease Activity Index (cSLEDAI)-2K=0, without prednisone or immunosuppressants; remission on-treatment: cSLEDAI-2K score=0, prednisone ≤5 mg/day and/or maintenance immunosuppressants; low disease activity Toronto cohort (LDA-TC): cSLEDAI-2K score of ≤2, without prednisone or immunosuppressants; modified lupus low disease activity (mLLDAS): Systemic Lupus Erythematosus Disease Activity Index-2K score of 4 with no activity in major organ/systems, no new disease activity, prednisone ≤7.5 mg/day and/or maintenance immunosuppressants; active: all remaining visits. Only the most stringent definition was used per visit. Antimalarials were allowed in all. The proportion of time that patients were in a specific state at each visit since cohort entry was determined. Damage accrual was ascertained with the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). Univariable and multivariable generalised estimated equation negative binomial regression models were used. Time-dependent covariates were determined at the same annual visit as the disease activity state but the SDI at the subsequent visit. Results: There were 1652 patients, 1464 (88.6%) female, mean age at diagnosis 34.2 (SD 13.4) years and mean follow-up time of 7.7 (SD 4.8) years. Being in remission off-treatment, remission on-treatment, LDA-TC and mLLDAS (per 25% increase) were each associated with a lower probability of damage accrual (remission off-treatment: incidence rate ratio (IRR)=0.75, 95% CI 0.70 to 0.81; remission on-treatment: IRR=0.68, 95% CI 0.62 to 0.75; LDA: IRR=0.79, 95% CI 0.68 to 0.92; and mLLDAS: IRR=0.76, 95% CI 0.65 to 0.89)). Conclusions: Remission on-treatment and off-treatment, LDA-TC and mLLDAS were associated with less damage accrual, even adjusting for possible confounders and effect modifiers.
KW - epidemiology
KW - outcome assessment, health care
KW - systemic lupus erythematosus
UR - http://www.scopus.com/inward/record.url?scp=85136542044&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/ard-2022-222487
DO - https://doi.org/10.1136/ard-2022-222487
M3 - Article
C2 - 35944946
SN - 0003-4967
VL - 81
SP - 1541
EP - 1548
JO - Annals of the rheumatic diseases
JF - Annals of the rheumatic diseases
IS - 11
M1 - 222487
ER -