背景:目前,已经提出了将狼疮低疾病活动度状态(LLDAS)作为可实现的目标的治疗靶向方法.
目的:确定儿童期发病的系统性红斑狼疮(c-SLE)患者在治疗后12个月内达到LLDAS相关的损害累积和基线临床特征。
方法:这项回顾性队列研究是在泰国最大的大学三级转诊中心进行的。收集2009年1月至2019年12月期间随访≥12个月的c-SLE患者(≤18岁)的数据。SLE疾病状态分为LLDAS和非最佳控制状态。SLEDAI-2K评分用于评估疾病活动性。通过儿童版本的SLICC/ACR损伤指数评估损伤发生。
结果:共纳入232例c-SLE患者(85.8%为女性)。在治疗12个月时,109例(47%)患者取得LLDAS。在平均6.2±3.7年的随访时间内,93例(40.1%)患者发生了损伤。在12个月内达到LLDAS的患者的损害累积显着低于非最佳控制的患者(p=0.002)。实现LLDAS的中位时间为12.6个月(95CI:11.19-13.97)。在没有肾脏受累的患者中,达到LLDAS的中位时间显著缩短(10.8个月,95CI:9.62-12.00vs.15.6个月,95CI:分别为13.76-17.52;p=0.044)。多变量逻辑回归分析显示,在治疗12个月内没有肾脏受累作为实现LLDAS的预测因子(aOR:2.430,95CI:1.420-4.158;p=0.001)。
结论:在治疗12个月内实现LLDAS与较低的损伤发生率相关。无肾脏受累是治疗12个月内达到LLDAS的预测因子。要点•LLDAS是c-SLE中一个有前途且可实现的治疗目标。•在治疗的12个月内实现LLDAS与较低的损害累积相关。•没有肾脏受累是在治疗12个月内实现LLDAS的预测因子。
BACKGROUND: At present, the treat-to-target approach has been proposed with the lupus low disease activity state (
LLDAS) as an achievable target.
OBJECTIVE: To determine damage accrual and baseline clinical characteristics associated with achieving LLDAS within 12 months of treatment in patients with childhood-onset systemic lupus erythematosus (c-SLE).
METHODS: This retrospective cohort study was conducted at the largest university-based tertiary referral center in Thailand. Data of c-SLE patients (≤ 18 years) at diagnosis who were followed ≥ 12 months during January 2009 to December 2019 were collected. SLE disease status was categorized into
LLDAS and non-optimally controlled state. SLEDAI-2K score was used to assess disease activity. Damage accrual was assessed by a pediatric version of the SLICC/ACR damage index.
RESULTS: A total of 232 c-SLE patients (85.8% female) were included. At 12 months of treatment, 109 (47%) patients achieved
LLDAS. Damage accrual was observed in 93 (40.1%) patients at the mean follow-up time of 6.2 ± 3.7 years. Damage accrual was significantly lower in patients who achieved LLDAS within 12 months than in those non-optimally controlled (p = 0.002). The median time to achieving
LLDAS was 12.6 months (95%CI: 11.19-13.97). The median time to achieving LLDAS was significantly shorter in those without renal involvement (10.8 months, 95%CI: 9.62-12.00 vs. 15.6 months, 95%CI: 13.76-17.52, respectively; p = 0.044). Multivariable logistic regression analysis revealed absence of renal involvement as the predictor of achieving LLDAS within 12 months of treatment (aOR: 2.430, 95%CI: 1.420-4.158; p = 0.001).
CONCLUSIONS: Achieving LLDAS within 12 months of treatment was associated with lower damage accrual. Absence of renal involvement was the predictor of achieving LLDAS within 12 months of treatment. Key Points •
LLDAS is a promising and achievable treatment target in c-SLE. • Achieving
LLDAS within 12 months of treatment is associated with lower damage accrual. • Absence of renal involvement is the predictor of achieving LLDAS within 12 months of treatment.