Editorial theme | LLDAS versus remission as treat-to-target goals

During a meeting of the Lupus Hub Steering Committee, Ricard Cervera chaired a recorded discussion that also featured Murray Urowitz, Mandana Nikpour, Betty Diamond, James Cheng-Chung Wei, Manuel Francisco Ugarte-Gil, and Lyndsy Ambler. The topic of this discussion was Lupus Low Disease Activity State (LLDAS) versus remission as treat-to-target goals, and is the second part of our editorial theme on treatment goals.

Ugarte-Gil and Nikpour open this discussion by providing the definition and differences between remission and LLDAS; highlighting remission as the absence of any disease activity, whilst LLDAS allows for a minimal amount. Acceptable disease activity in LLDAS is defined by a Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score of ≤4, Physician Global Assessment of ≤1, and a maximum corticosteroid dose of 7.5 mg daily. More information on these definitions can be found in our editorial theme article on treat-to-target in SLE.

The discussion continues with an examination of these definitions, particularly around the absence of the patient experience, such as type 2 symptoms including fatigue, pain, and cognitive impairment. The limitations of both goals for a treat-to-target strategy are discussed and there is a suggestion that the definitions of these treatment goals may be refined to incorporate type 2 symptoms as and when there are therapeutic options that treat both type 1 and type 2 symptoms of the disease. Discussions continue around trials of LLDAS versus remission, and on to what the aim of treatment should be with newly diagnosed patients compared with those who have had disease for longer.

This session concludes with an agreement that all treatment strategies should strive toward the best possible outcome for the patient, aiming for remission in all patients, plus a reduction in flares as much as possible.