Predictors of predominant Lupus Low Disease Activity State (LLDAS-50)

Area of Science:

• Rheumatology
• Immunology
• Clinical Medicine

Background:

• Systemic lupus erythematosus (SLE) management aims to minimize organ damage and mortality.
• Lupus Low Disease Activity State (LLDAS) is a key treat-to-target goal in SLE.
• Achieving LLDAS for over 50% of observation time significantly reduces organ damage and mortality risk.

Purpose of the Study:

• To identify predictors of achieving LLDAS for ≥50% of the observation time (LLDAS-50) in a large SLE cohort.
• To understand factors associated with sustained LLDAS achievement in SLE patients.

Main Methods:

• A cohort of 2228 SLE patients with at least three clinical visits was analyzed.
• LLDAS-50 was defined as being in LLDAS for ≥50% of the observation period.
• Logistic regression with stepwise selection identified predictors of LLDAS-50.

Main Results:

• 52.5% of SLE patients achieved LLDAS-50; only 37.6% of African Americans did.
• Negative predictors included African American ethnicity, hypocomplementemia, serositis, renal activity, arthritis, anti-RNP, anti-dsDNA, vasculitis, malar rash, discoid rash, thrombocytopenia, and immunosuppressive use.
• Positive predictors were older age at diagnosis, longer disease duration, higher education, and greater time on hydroxychloroquine.

Conclusions:

• Only half of SLE patients achieved LLDAS-50, with lower rates in African Americans.
• Hydroxychloroquine adherence is a modifiable factor positively predicting LLDAS-50.
• Specific autoantibodies (anti-RNP, anti-dsDNA) and low complement are negative predictors, highlighting the need for targeted therapies and inclusion of diverse populations in trials.