Lower Lupus Activity, Lower Mortality

Data from the longitudinal Tromsø Lupus Cohort study has shown that lupus patients who achieve a Lupus Low Disease Activity State (LLDAS‐50) were shown to have significantly less severe damage, and a reduction in mortality.

This analysis was a population‐based study of systemic lupus erythematosus (SLE) patients living in northern Norway. The researchers collected data on the LLDAS, defined as:

• SLE Disease Activity Index 2000 ≤4, with no activity in major organ systems

• No new features of lupus disease activity

• Current prednisolone (or equivalent) dose ≤7.5 mg daily

• Well-tolerated standard maintenance doses of immunosuppressive drugs

The investigators followed a total of 206 SLE patients, 84% of whom were female, for a median of 125 months. Overall, 46 patients (22%) in the cohort died.

Prednisolone (89%) and hydroxychloroquine (59%) were the most common drugs used. Only 3.4% of patients required cyclophosphamide or rituximab. A positive anti-nuclear antibody was evident in nearly all (96%).

LLDAS was achieved by 74% of the cohort. The median time in LLDAS was 34 months, and 69 patients (33.5%) spent at least half of their time in LLDAS.

The authors observed lower mortality rates and a lower risk of severe damage in the 69 patients (33.5%) who spent at least half of their follow-up time in LLDAS.

The LLDAS‐50 was associated with a significantly lower risk of having severe damage (HR 0.37, 95%CI 0.19-0.73, P<0.01), and also a reduction in mortality (HR 0.31, 95%CI 0.16-0.62, P<0.01).

The study showed that treat-to-target and low disease activity can have a powerful effect on lupus outcomes.

Jack Cush, MD, is the director of clinical rheumatology at the Baylor Research Institute and a professor of medicine and rheumatology at Baylor University Medical Center in Dallas. He is the executive editor of RheumNow.com. A version of this article first appeared on RheumNow, a news, information and commentary site dedicated to the field of rheumatology. Register to receive their free rheumatology newsletter.