Remission and low disease activity in systemic lupus erythematosus

Abstract

The treat-to-target strategy has significantly improved patient outcomes in several non-rheumatological disorders, such as diabetes mellitus, hypercholesterolemia, and arterial hypertension. This approach has also been successfully applied to certain rheumatological conditions, including rheumatoid arthritis, psoriatic arthritis, and spondyloarthropathies, and it has been proposed for systemic lupus erythematosus (SLE). However, identifying treatment targets in SLE remains challenging. The 2023 European Alliance of Associations for Rheumatology (EULAR) recommendations for SLE management emphasize remission or low disease activity (LDA) as the ideal treatment goals. Within this framework, the Definitions of Remission in SLE (DORIS) and Lupus Low Disease Activity State (LLDAS) are used to define remission and LDA, respectively, and also serve as secondary endpoints in an increasing number of randomized controlled trials. Achieving DORIS or LLDAS is associated with reduced mortality and improved health-related quality of life. Furthermore, reaching remission or LDA correlates with favorable patient outcomes, including fewer disease flares and lower damage accrual. Nevertheless, ongoing debates persist regarding the definitions of these states. This review aims to provide valuable insights into the main target disease activity states, highlighting their respective strengths and limitations in the context of clinical practice and future research.

Keywords

Remission / low disease activity / systemic lupus erythematosus / DORIS / LLDAS

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