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LUPUS Topics || ASC05 DISEASE ACTIVITY AND DISEASE FLARES, LUPUS Topics || ASC25 TREAT TO TARGET, REMISSION AND LOW-DISEASE ACTIVITY, No Topic Needed
- Ian Bruce (United Kingdom)
- Eric F. Morand (Australia)
New Insights into Activity, Organ Damage and Co-Morbidity of SLE
- Michelle Petri (United States of America)
Live Q&A
New perspective in measuring disease activity and in defining T2T goals
- Luís Sousa Inês (Portugal)
Live Q&A
The patient’s view in the disease assessment
- Chiara Tani
Live Q&A
DOES EXPERT OPINION MATCH THE DEFINITIONS OF LOW DISEASE ACTIVITY STATE? PROSPECTIVE ANALYSIS OF 500 PATIENTS FROM A SPANISH MULTICENTER COHORT.
- Irene Altabás González (Spain)
Abstract
Background and Aims
Treat to Target strategies are necessary in Systemic Lupus Erythematosus (SLE). AIM: To quantify the proportion of patients in Low Disease Activity State (LLDAS) and remission according to DORIS definition. Evaluate the concordance between the LLDAS and the clinical status according to the expert opinion.
Methods
Prospective multicenter study of SLE patients from Spain. A descriptive cross-sectional analysis and evaluation of the level of agreement between rheumatologist and LLDAS using Cohen’s kappa was made.
Results
Five hundred and eight patients were included (92% women; 50.4 years (±13.7)). The mean SLEDAI-2K (±SD) was 2.84 (±3.31). A total of 406 (79.9%) patients presented SLEDAI-2K≤4. A total of 317 (74.1%) patients were on antimalarial treatment and 222 (43.7%) were on some type of immunosuppressive or biological therapy. More than half of patients were not taking glucocorticoids (n=310, 61%). 54.4% (n = 267) of patients were in clinical remission on treatment and 27.3% (n=133) were in clinical remission off treatment (only antimalarials allowed). Two hundred eigtheen patients (46.4 %) were in complete remission on treatment, and 24.4% (n=118) in complete remission off treatment. A total of 304 (62.7%) patients were in LLDAS. According to the expert opinion, remission is the most frequent state considered (n=206, 41.6%). Overall agreement between expert opinion and LLDAS was 70.4 % with a Cohen’s kappa of 0.72
Conclusions
At a given point in time, more than half of SLE patients were in remission on treatment or in LLDAS. The overall agreement between expert opinion and the operational definitions of LLDAS is very good.
Live Q&A
ASSESSING THE IMPACT OF PHYSICIAN GLOBAL ASSESSMENT ON DORIS REMISSION RATES IN SLE - ANALYSIS FROM A GERMAN SLE-COHORT
- Johanna Mucke (Germany)
Abstract
Background and Aims
According to Definitions Of Remission In SLE (DORIS), remission is defined as a sustained state without any symptoms of SLE, assessing disease activity by cSLEDAI and evaluating the global patient status with the physician global assessment (PGA). PGA reflects the overall clinician-based evaluation, complementing the cSLEDAI. However, controversial opinions regarding the added value of PGA impede its standardized implementation which led us to assess the impact of PGA on DORIS remission rates in our SLE cohort.
Methods
In this monocentric cross-sectional study, patients with SLE were enrolled in 2016/2017. All patients were evaluated for DORIS remission and a modified version of DORIS remission excluding PGA. In addition, physicians were asked if they considered their patient in remission regardless of objective remission criteria. Regression analyses were performed to assess factors influencing PGA.
Results
Of the 233 patients included, 99 patients fulfilled any of the four DORIS remission definitions. On exclusion of PGA, remission rates increased by 57 to 156 patients in any modified remission with a similar increase in each DORIS subgroup. Of the 57 patients, 30 were not considered in remission by their treating physician. Regression analyses revealed an association of PGA with pain reported by the patient and hypocomplementemia. Damage did not influence PGA. (Table 1)
Conclusions
Exclusion of PGA in remission assessment led to an increased number of patients in remission without affecting clinical, serological or mental parameters. The use and especially the ideal threshold of PGA for remission still has to be discussed.