Objective High disease activity status (HDAS) in patients with systemic lupus erythematosus (SLE) is associated with adverse long-term outcomes. We examined the frequency of lupus low disease activity state (LLDAS) and remission (REM) attainment in HDAS patients and whether their attainment was associated with improved patient outcomes. Methods Demographic, clinical and outcomes data, collected prospectively from a multinational cohort between 2013 and 2020, were analysed. Disease activity was assessed using SLEDAI-2K. HDAS was defined as SLEDAI-2K ≥ 10. Patients’ first visit with SLEDAI-2K ≥ 10 was assigned as baseline. Survival analyses were performed to examine the associations between cumulative and sustained LLDAS and REM attainment in HDAS patients and subsequent organ damage accrual and flare. Results 1,029 HDAS patients with a median study duration of 2.7 years [IQR: 1.0, 4.8] were studied. LLDAS and REM were attained at least once by 71% (LLDAS-ever, n = 726) and 41% (REM-ever, n = 418) of patients. Approximately one-fifth of patients attained ≥50% cumulative time in LLDAS or REM. 37% (n = 385) of patients attained ≥3months of sustained LLDAS, with progressively lower proportions of patients attaining longer periods of sustained LLDAS. Lower proportions of patients attained sustained REM. Attainment of cumulative and sustained LLDAS or REM provided significant protection against damage accrual and flare in HDAS patients. Sustained periods of LLDAS and REM were difficult to achieve and therefore a more stringent target, but provided the most protection against damage accrual or flare. Conclusion LLDAS and REM were achievable targets in HDAS patients, and provided significant protection against adverse outcomes.

中文翻译：

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狼疮低疾病活动状态和缓解与疾病活动度高的系统性红斑狼疮患者器官损伤和耀斑减少的关系


目的 系统性红斑狼疮 （SLE） 患者的高疾病活动状态 （HDAS） 与不良长期结局相关。我们检查了 HDAS 患者狼疮低疾病活动状态 （LLDAS） 和缓解 （REM） 达到的频率，以及它们的达到是否与患者预后改善相关。方法 分析了 2013 年至 2020 年间前瞻性地从跨国队列中收集的人口统计学、临床和结果数据。使用 SLEDAI-2K 评估疾病活动度。HDAS 定义为 SLEDAI-2K ≥ 10。将患者首次使用 SLEDAI-2K ≥ 10 次就诊指定为基线。进行生存分析以检查 HDAS 患者累积和持续 LLDAS 与 REM 达标与随后器官损伤累积和发作之间的关联。结果 研究了 1,029 例 HDAS 患者，中位研究持续时间为 2.7 年 [IQR： 1.0， 4.8]。71% （LLDAS-ever， n = 726） 和 41% （REM-ever， n = 418） 的患者至少达到一次 LLDAS 和 REM。大约五分之一的患者在 LLDAS 或 REM 中达到了 ≥50% 的累积时间。37% （n = 385） 的患者达到了 ≥3 个月的持续 LLDAS，而获得更长时间持续 LLDAS 的患者比例逐渐降低。获得持续 REM 的患者比例较低。累积和持续 LLDAS 或 REM 的实现为 HDAS 患者提供了对损伤累积和耀斑的显着保护。LLDAS 和 REM 的持续时间很难实现，因此目标更严格，但对损伤累积或发作提供了最大的保护。结论 LLDAS 和 REM 是 HDAS 患者可实现的靶点，对不良结局提供了显着保护。