Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Division of Rheumatology, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey.
Lupus. 2019 Dec;28(14):1648-1655. doi: 10.1177/0961203319886028. Epub 2019 Nov 6.
The Lupus Low Disease Activity State (LLDAS) is a potential treat to target goal in systemic lupus erythematosus (SLE). SLE patients in LLDAS for more than half of the observation time have about a 50% lower risk of new organ damage and have reduced mortality. We identified predictors of being in LLDAS ≥50% of the observation time.
A total of 2228 SLE patients who had at least three clinical visits were included. Percentage of time in LLDAS was calculated based on the proportion of days under observation. LLDAS-50 was defined as being in LLDAS for ≥50% of the observation time. We used the stepwise selection procedure in logistic regression to identify predictors of LLDAS-50.
A total of 1169 (52.5%) SLE patients, but only 37.6% of African Americans, achieved LLDAS-50. In the multivariable model, African American ethnicity, hypocomplementemia, serositis, renal activity, arthritis, anti-RNP, anti-dsDNA, vasculitis, malar rash, discoid rash, thrombocytopenia, and immunosuppressive use were negative predictors of LLDAS-50. Older age at diagnosis, longer disease duration, higher education level, and greater percentage of time taking hydroxychloroquine remained positive predictors of LLDAS-50.
In this large cohort, only 52.5% achieved LLDAS-50. This proportion was even less in African Americans. A higher percentage of time taking hydroxychloroquine was a modifiable positive predictor of LLDAS-50. Anti-RNP, anti-dsDNA, and low complement were negatively associated with LLDAS-50. Our findings further emphasize the importance of inclusion of African Americans in clinical trials and hydroxychloroquine adherence in both clinical practice and clinical trials.
狼疮低疾病活动状态（LLDAS）可能是系统性红斑狼疮（SLE）的治疗目标。处于 LLDAS 的 SLE 患者超过一半的观察时间，新器官损伤的风险降低约 50%，死亡率降低。我们确定了处于 LLDAS 状态≥50%观察时间的预测因素。
共纳入 2228 例至少有 3 次就诊的 SLE 患者。根据观察天数的比例计算 LLDAS 时间百分比。定义 LLDAS-50 为处于 LLDAS 状态≥50%的观察时间。我们使用逐步选择程序进行逻辑回归，以确定 LLDAS-50 的预测因素。
共有 1169 例（52.5%）SLE 患者，而非裔美国人仅为 37.6%，达到 LLDAS-50。在多变量模型中，非裔美国人种族、低补体血症、浆膜炎、肾脏活动、关节炎、抗 RNP、抗 dsDNA、血管炎、蝶形皮疹、盘状皮疹、血小板减少症和免疫抑制治疗是 LLDAS-50 的负预测因素。诊断时年龄较大、疾病持续时间较长、教育程度较高以及羟氯喹治疗时间比例较高，均为 LLDAS-50 的正预测因素。
在这项大型队列研究中，只有 52.5%的患者达到 LLDAS-50。非裔美国人的这一比例甚至更低。羟氯喹治疗时间比例较高是 LLDAS-50 的可修改正预测因素。抗 RNP、抗 dsDNA 和低补体与 LLDAS-50 呈负相关。我们的研究结果进一步强调了将非裔美国人纳入临床试验以及在临床实践和临床试验中坚持使用羟氯喹的重要性。
