Usefulness of remission criteria in Japanese patients with systemic lupus erythematosus（SLE）: Lupus Low Disease Activity State（LLDAS）and Definitions of Remission in SLE（DORIS）

Abstract

Objective　To evaluate usefulness of remission criteria of SLE.

Methods　Medical record of eighty-three Japanese SLE patients were reviewed. Lupus Low Disease Activity State（LLDAS）was defined as SLEDAI ≦4 and prednisolone（PSL）≦7.5mg/day. Definitions of Remission in SLE（DORIS）included patients with clinical and complete remission, clinical remission on treatment（ROT）, and complete ROT.

Results　All remissions（DORIS）had LLDAS, and 78.4% of LLDAS had remission. At enrollment, 61.4% had LLDAS; 22.9%, clinical ROT; and 25.3%, complete ROT. Two patients with clinical remission（1.4%）had a relapse, but no patients with complete remission had no relapse. The flare occurred in 69.9% of 79 clinical ROT and 45.7% of 35 complete ROT. Patients who achieved LLDAS in more than half of observation period or DORIS remissions significantly received 2.5mg/day of PSL, had fewer instances of nephropathy and lower SLICC/ACR damage index（SDI）than those with LLDAS < 50% or without remission. The multivariate analysis showed that flares and renal involvement were risk factors, but PSL 2.5mg/day was protective against damage accrual. Patients taking PSL 2.5mg/day had significantly less relapses and lower SDI than patients taking PSL 5 to 7.5mg/day. The present study demonstrated that the best therapeutic strategy would be firstly achieving LLDAS with PSL ≦7.5mg/day, followed by clinical or complete ROT with PSL ≦5mg/day, and finally clinical or complete ROT with PSL 2.5mg/day. Corticosteroid-off remission should be avoided in terms of preventing flares.

Conclusion　LLDAS and DORIS remissions tightly overlap each other. LLDAS may be a useful indicator of remission, and DORIS will be valuable to evaluate the degree of achieved remission.