The following is a summary of “Lupus low disease activity state and remission and risk of mortality in patients with systemic lupus erythematosus: a prospective, multinational, longitudinal cohort study,” published in the December 2022 issue of Rheumatology by Kandane-Rathnayake, et al.
Patients with systemic lupus erythematosus (SLE) have been shown to benefit from treat-to-target aims, which have been shown to reduce the risk of organ damage and increasing patient satisfaction. The research aimed to examine whether or not SLE patients who achieved a lupus low disease activity status (LLDAS) also had remission and a lower risk of death. According to the supposition, LLDAS is correlated with a reduced chance of dying prematurely. Adults (aged≥18) who met the modified 1997 American College of Rheumatology or the updated 2012 Systemic Lupus International Collaborating Clinics categorization criteria for SLE were considered for inclusion. LLDAS, remission, and variants of remission with lower glucocorticoid thresholds were the main exposure variables, and all-cause death was the key outcome.
Longitudinal correlations between these proxies and mortality risk were analyzed using survival analysis. Of the initial 4,106 patients, 3,811 (92.8%) were included in the final analysis (median follow-up 2.8 years [interquartile range [(IQR) 1.0–5.3]; 3,509 [92.1%] women and 302 [7.9%] men), and 80 of them passed away during the course of observation (a crude mortality rate of 6.4 deaths per 1,000 person-years). Only 43 (53.8%) of the 80 study participants who passed away achieved LLDAS at least once, while 3,035 (81.3%) of the 3,731 study participants who were still alive at the end of the study did so (P<0001); only 22 (27.5%) of the 80 study participants who passed away achieved LLDAS for at least 50% of the observed time, while 1,966 (52.7%) of the 3731 study participants who were still alive at the end of the study did so. About 32 (40.0%) of the 80 people who did not survive the study achieved remission, while 2403 (64.4%) of the 3731 people who did survive the study did so (P<0.0001); 14 (17.5%) of the people who did not survive the study versus 1,389 (37.2%) of the people who did survive the study achieved remission for at least 50% of the time that they were observed.
Reduced mortality risk was seen among those who had LLDAS for at least half of the time seen (adjusted hazard ratio 0.51 [95% CI 0.31-0.85]; P=0.010) and among those who had been in remission for at least half of the time observed (0.52 [0.25-0.93]; P=0.027). Mortality was reduced by (0.31 [0.12-0.77]; P=0.012) when the glucocorticoid threshold for remission was lowered to (<5.0 mg/day prednisolone), compared to the present remission definitions and by (0·13 [0·02–0·96]; P=0·046) when glucocorticoid-free remission was used. Patients with SLE who received LLDAS had a considerably lower probability of dying. Compared to LLDAS, the risk of death did not decrease further during remission unless lower glucocorticoid thresholds were utilised.
Source: sciencedirect.com/science/article/abs/pii/S2665991322003046