DORIS - Defining Remission in Lupus Save

Proponents of treat to target in systemic lupus erythematosus (SLE) have all agreed that "remission" should be the goal, but defining remission may be tricky in SLE.  A SLE Definitions Of Remission (DORIS)Task Force was convened in 2015 and first published their work in 2016. Now the 2021 DORIS definition of remission in SLE has been finalized and is recommended for use in clinical care, education, and research,  including clinical trials and observational studies.

The DORIS task force included specialists in rheumatology, nephrology, dermatology, clinical immunology and patient representatives. Panelist drew from systematic literature reviews and used specific research questions and answers from chosen data sets.

The DORIS Task Force definition of remission in SLE is based on clinical systemic lupus erythematosus disease activitiy index (SLEDAI)=0, Evaluator’s Global Assessment <0.5 (0–3), prednisolone 5 mg/day or less, and stable doses of antimalarials, immunosuppressives, and/or biologics.

In their recommendations the task force were clear in stating that:

• Serology (anti-dsDNA, complement) is not included in the DORIS definition of remission on-treatment.

• Duration was omitted.  While the goal is sustained remission, the goal of remission can be met at any point in time

• Preponderence of use lead to the SLEDAI being used over BILAG-based or European consensus lupus activity measure (ECLAM)

• Remission off-treatment is the ultimate goal but is rarely achieved 

• LLDAS (lupus low disease activity state) is different than DORIS remission. Both should be used as outcomes in lupus studies.

This comprehensive definition of remission utilizes a validated disease activity metric, physician global assessment and stable immunosuppressive status. The 2021 DORIS definition of remission in SLE is recommended for use in clinical care, education, and research.