OP0330 #X00A0; COMPARISON OF THE EFFECTS OF DORIS REMISSION AND LUPUS LOW DISEASE ACTIVITY STATE (LLDAS) ON DISEASE OUTCOMES IN A MULTINATIONAL PROSPECTIVE STUDY
Authors: Vera Golder, Eric F. Morand, Rangi Kandane-Rathnayake, Molla Huq, Worawit Louthrenoo, Shue Fen Luo, Yeong-Jian Wu, Aisha Lateef, Sargunan Sockalingam, Sandra Navarra, Leonid Zamora, Laniyati Hamijoyo, Yasuhiro Katsumata, Masayoshi Harigai, Madelynn Chan, Sean O’neill, Fiona Goldblatt, Chak Sing Lau, LI Zhanguo, Alberta Hoi, Mandana Nikpour
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> The Definitions of Remission in SLE (DORIS) group has proposed multiple definitions of remission, but these are infrequently attained and have not been prospectively evaluated in relation to protection from damage accrual. In contrast, the Lupus Low Disease Activity State (LLDAS) is more attainable, and has been shown to be associated with improved patient outcomes. <h3>Objectives</h3> To compare the attainability, and association with outcomes, of LLDAS and remission in a prospective multicentre study. <h3>Methods</h3> A prospective multinational cohort study was undertaken in 13 centres between 2013-2017. Time dependent Cox proportional hazards models were used to compare LLDAS and DORIS definitions of remission in terms of impact on disease flares and damage accrual. <h3>Results</h3> 1735 SLE patients were recruited, and followed for (mean±SD) 2.2±0.9 years, totalling 12,717 visits. LLDAS was achieved in 47.2% of observed visits. In contrast, remission was achieved in 1.1%-15.4% of visits depending on the stringency of remission definition. LLDAS attainment at any visit was associated with significantly reduced subsequent flare (HR 0.65, 95%CI 0.56-0.75, p&lt;0.001) and damage accrual (HR 0.59, 95%CI 0.45-0.76, p&lt;0.001). In contrast, only the least stringent remission definition was associated with reduced damage accrual (HR 0.58, 95%CI 0.39-0.88, p 0.01). Only remission definitions including serological remission were significantly associated with reduction in subsequent flares. Patients who spent ≥50% of their observed time in LLDAS had reduction in damage accrual (HR 0.54, 95% CI 0.42- 0.70, p&lt;0.001) compared to patients with &lt;50% of observed time in LLDAS; again, only the least stringent remission definition, or the related definition excluding serology, were associated with reduced damage (HR 0.59, 95% CI 0.42-0.83, p 0.003; HR 0.69, 95% CI 0.48-0.99, p 0.05, respectively). <h3>Conclusion</h3> LLDAS was more attainable than any remission definition, whilst still conferring significant reduction in flares and damage accrual. Only the least stringent remission definitions could be shown to be associated with significantly lower damage accrual, likely reflecting a low frequency of remission attainment overall. LLDAS is a valid treatment target for SLE and is more achievable than remission. <h3>Disclosure of Interests</h3> Vera Golder: None declared, Eric F. Morand Grant/research support from: AstraZeneca, Bristol Myers Squibb, Janssen, Merck Serono, and UCB, Consultant for: AstraZeneca, Eli Lilly, Janssen, and Merck Serono, Speakers bureau: AstraZeneca, Rangi Kandane-Rathnayake: None declared, Molla Huq: None declared, Worawit Louthrenoo: None declared, Shue Fen Luo: None declared, Yeong-Jian Wu: None declared, Aisha Lateef : None declared, Sargunan Sockalingam: None declared, Sandra Navarra: None declared, Leonid Zamora: None declared, Laniyati Hamijoyo: None declared, Yasuhiro Katsumata: None declared, masayoshi harigai Grant/research support from: Tokyo Women’s Medical University (TWMU) has received unrestricted research grants for Division of Epidemiology and Pharmacoepidemiology of Rheumatic Diseases from Ayumi Pharmaceutical Co. Ltd., Bristol Meyers Squib, Chugai Pharmaceutical Co. Ltd., Nippon Kayaku Co. Ltd., Taisho Toyama Pharmaceutical Co. Ltd., Mitsubishi Tanabe Pharma Corp., and with which TWMU paid the salary of MH. MH has also received research grants from AbbVie Japan GK, Eisai Co. Ltd., Takeda Pharmaceutical Co., Ltd., and Teijin Pharma Ltd., Madelynn Chan: None declared, Sean O’Neill: None declared, Fiona Goldblatt: None declared, Chak Sing Lau: None declared, Zhanguo Li: None declared, Alberta Hoi Grant/research support from: GSK, AstraZeneca, UCB and Merck Serono, Consultant for: Janssen Steering Committee, Speakers bureau: Novartis, Mandana Nikpour: None declared