Usefulness of the lupus low disease activity state as a treatment target in childhood-onset SLE.
Usefulness of the lupus low disease activity state as a treatment target in childhood-onset SLE.
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DOI：
10.1136/lupus-2022-000884
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发表时间：
2023-05
影响因子：
3.9
通讯作者：
中科院分区：
文献类型：
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作者：
Treat-to-target (T2T) strategies are advocated to improve prognosis in childhood-onset SLE (cSLE). Proposed T2T states include SLEDAI score of <4 (SLEDAI-LD), limited corticosteroid use (low-CS), and lupus low disease activity state (LLDAS). We sought to compare T2T states for their association with cSLE prognosis under consideration of relevant disease characteristics such as pre-existing damage, race and lupus nephritis (LN). Longitudinal data from 165 patients enrolled in the Cincinnati Lupus Registry were included. LN presence was based on renal biopsy, and patients were followed up until 18 years of age. The 165 patients (LN: 45, white: 95) entered the registry within a median of 0 (IQR: 0–1) year post diagnosis and were followed up for a median of 4 (IQR: 2–5) years during which 80%, 92% and 94% achieved LLDAS, low-CS and SLEDAI-LD. Patients with LN were significantly less likely to achieve any T2T state (all p<0.03) and required a significantly longer time to reach them (all p<0.0001). Over the study period, patients maintained low-CS, SLEDAI-LD or LLDAS for a median of 76% (IQR: 48%–100%), 86% (IQR: 55%–100%) or 39% (IQR: 13%–64%) of their follow-up. Significant predictors of failure to maintain LLDAS included LN (p≤0.0062), pre-existing damage (p≤0.0271) and non-white race (p≤0.0013). There were 22%, 20% and 13% of patients who reached SLEDAI-LD, CS-low and LLDAS and nonetheless acquired new damage. Patients with LN had a higher risk of new damage than patients without LN even if achieving low-CS (p=0.009) or LLDAS (p=0.04). Patients with LN and pre-existing damage are at higher risk of increased future damage acquisition, even if achieving a T2T state such as LLDAS. Among proposed common T2T states, the LLDAS is the hardest to achieve and maintain. The LLDAS may be considered the preferred T2T measure as it conveys the highest protection from acquiring additional disease damage.
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影响因子：
--
作者：
Brunner, HI;Silverman, ED;Feldman, BM
通讯作者：
Feldman, BM
影响因子：
27.4
作者：
Bruce IN;O'Keeffe AG;Farewell V;Hanly JG;Manzi S;Su L;Gladman DD;Bae SC;Sanchez-Guerrero J;Romero-Diaz J;Gordon C;Wallace DJ;Clarke AE;Bernatsky S;Ginzler EM;Isenberg DA;Rahman A;Merrill JT;Alarcón GS;Fessler BJ;Fortin PR;Petri M;Steinsson K;Dooley MA;Khamashta MA;Ramsey-Goldman R;Zoma AA;Sturfelt GK;Nived O;Aranow C;Mackay M;Ramos-Casals M;van Vollenhoven RF;Kalunian KC;Ruiz-Irastorza G;Lim S;Kamen DL;Peschken CA;Inanc M;Urowitz MB
通讯作者：
Urowitz MB
影响因子：
4.7
作者：
Mina R;Abulaban K;Klein-Gitelman MS;Eberhard BA;Ardoin SP;Singer N;Onel K;Tucker L;O'neil K;Wright T;Brooks E;Rouster-Stevens K;Jung L;Imundo L;Rovin B;Witte D;Ying J;Brunner HI
通讯作者：
Brunner HI
影响因子：
4.7
作者：
Aljaberi, Najla;Nguyen, Kim;Brunner, Hermine I.
通讯作者：
Brunner, Hermine I.
影响因子：
4.9
作者：
Golder, Vera;Kandane-Rathnayake, Rangi;Nikpour, Mandana
通讯作者：
Nikpour, Mandana