Comparison of Remission and Lupus Low Disease Activity State in Damage Prevention in a United States Systemic Lupus Erythematosus Cohort

Objective: One objective in the treatment of systemic lupus erythematosus (SLE) disease activity is to reduce long-term rates of organ damage. We undertook this study to analyze data from a large clinical SLE cohort to compare patients achieving different levels of disease activity with respect to rates of long-term damage. Methods: We analyzed data from 1,356 SLE patients in the Hopkins Lupus Cohort, followed up quarterly, with 77,105 person-months observed from 1987 to 2016. Three outcome measures were considered: clinical remission with no treatment, clinical remission on treatment, and lupus low disease activity state (LLDAS). Results: Patients achieved LLDAS in 50% of their follow-up months. They achieved clinical remission with no treatment or clinical remission on treatment in only 13% and 27%, respectively, of their follow-up visits. The rates of damage consistently declined with increased percentage of prior time in either LLDAS or clinical remission on treatment. Spending a short proportion of prior time (<25%) in clinical remission on treatment was associated with a relatively low rate of damage compared to never achieving that condition (1.01 events per 10 person-years versus 1.82 events per 10 person-years; rate ratio 0.54, P < 0.0001). Those patients who experienced LLDAS at least 50% of the time had relatively low rates of damage (rate ratio 0.39–0.47, P < 0.0001). Conclusion: LLDAS is an easier target to achieve than clinical remission on treatment and results in reduced risk of long-term damage. However, even a small percentage of time in clinical remission on treatment was associated with reduced damage.