Recognizing Remission in Lupus
Recognizing Remission in Lupus

Researchers are trying to ascertain the important issue in SLE of how much improvement in disease activity patients must show to decrease the long-term rate of organ damage.  Four studies presented at ACR by Drs. Eric Morand and Michelle Petri addressed that important question.

Favorable Results for “Easier” Remission Target
Three studies by Distinguished Innovator Award recipient Eric Morand, PhD, of Monash University in Australia and colleagues show health benefits, with respect to disease flares and organ damage, for patients who attain a Lupus Low Disease Activity State (LLDAS) and reveal that LLDAS can help identify people who responded to treatment in clinical trials.

In two of the studies (Abstracts 2930 & 2786) , Dr. Morand and colleagues tracked more than 1,700 patients with lupus for over two years. They found that patients who spent more than half the time in LLDAS were less likely to have flares or to suffer additional organ damage. The researchers also compared LLDAS to several other standard tools for determining whether patients have entered remission. Their findings support using LLDAS as a goal for lupus treatment, rather than other remission criteria that are harder to achieve.

The third study by Dr. Morand’s team analyzed data from two phase 3 clinical trials (BLISS-52 and BLISS-76) that tested the drug belimumab (Benlysta). In one of the trials (BLISS-52), LLDAS was able to distinguish people who responded to treatment (responders) from non-responders in the belimumab 10mg/kg group. These findings suggest that LLDAS could be a useful outcome measure in lupus clinical trials, allowing researchers to determine whether other potential lupus treatments are working in trials.

Two Remission Yardsticks Measure Up
New findings from Michelle Petri, MD, MPH, of Johns Hopkins University School of Medicine in Baltimore, MD, and colleagues may set the stage for Treat-to-Target in SLE. Although remission is the goal, it is a hard target to achieve. Instead, the Lupus Low Disease Activity State (LLDAS) can be achieved three times more frequently.  In the Hopkins Lupus Cohort (over 2,000 patients), achieving LLDAS 50% of the time led to a 50% reduction in permanent organ damage. In particular, there was a dramatic, significant, reduction in later heart attack, stroke and end-stage kidney disease.

The research by Drs. Morand and Petri indicates that the LLDAS is a safe alternative to other remission standards and may be a better treatment target for patients and doctors.

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