Targeting DORIS Remission and LLDAS in SLE: A Review
Agner R Parra Sánchez1, Ronald F van Vollenhoven2, Eric F Morand3
1Amsterdam Rheumatology Center ARC, Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Centre, Amsterdam, The Netherlands. a.r.parrasanchez@amsterdamumc.nl.
Rheumatology and Therapy
|October 5, 2023
Summary
Achieving low disease activity (LLDAS) or remission (DORIS) in systemic lupus erythematosus (SLE) improves patient outcomes. Implementing these as treat-to-target goals may enhance care compared to standard approaches.
Area of Science:
- Rheumatology
- Immunology
- Clinical Medicine
Background:
- Systemic lupus erythematosus (SLE) treatment aims for remission, defined by the Definition Of Remission In SLE (DORIS) criteria.
- Achieving DORIS remission is infrequent in clinical practice.
- The Lupus Low Disease Activity State (LLDAS) offers a more attainable target for patients with SLE.
Purpose of the Study:
- To review the evolution of DORIS and LLDAS definitions in SLE.
- To examine evidence supporting clinical benefits of achieving DORIS or LLDAS.
- To discuss implementing DORIS and LLDAS as treat-to-target (T2T) objectives in SLE management.
Main Methods:
- Literature review of studies on DORIS and LLDAS in SLE.
- Analysis of clinical trial and real-world data on remission and low disease activity states.
- Discussion of treat-to-target principles in chronic inflammatory diseases.
Main Results:
- Both DORIS remission and LLDAS are associated with positive clinical outcomes in SLE.
- Treat-to-target approaches have shown improved outcomes in other inflammatory conditions.
- Evidence supports the benefits of achieving DORIS or LLDAS in SLE patients.
Conclusions:
- LLDAS provides a pragmatic and achievable treatment goal for a broader SLE population than DORIS remission.
- Implementing DORIS and LLDAS as T2T goals holds potential for improved patient outcomes in SLE.
- Further trials are needed to confirm the efficacy of T2T strategies using DORIS/LLDAS in SLE.
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