SLE T2T - Lupus Low Disease Activity State Predicts Outcomes Save

Treat-to-target (T2T) management of systemic lupus erythematosus (SLE) has been shown to protect against organ damage and to improve quality of life. Now a prospective study shows that T2T with a goal of lupus low disease activity state (LLDAS) and remission has been shown to improve mortality risk.

Data from SLE patients in the Asia Pacific Lupus Collaboration cohort was prospectively collected between May 1, 2013, and Dec 31, 2020. The primary outcome was all-cause mortality, and LLDAS, remission, and variations of remission with lower glucocorticoid thresholds.

From 4106 SLE patients in the cohort, 3811 (93%) patients were included in the final analysis (median follow-up 2·8 years, 92% women).  A total of 80 died (crude mortality rate 6·4 deaths per 1000 person-years).

Outcomes according to disease activity is shown below.

Modifying the remission glucocorticoid threshold (<5·0 mg/day prednisolone) was more protective against mortality than current remission definitions (0·31 [0·12–0·77]; p=0·012), and glucocorticoid-free remission was the most protective (0·13 [0·02–0·96]; p=0·046).

T2T is effective in reducing mortality risk in SLE. Achieving LLDAS is the goal.  Remission did not further reduce the risk of mortality compared with LLDAS, unless lower glucocorticoid thresholds were used.