LLDAS-5: A clinically meaningful, glucocorticoid-sparing target in SLE

Results from a longitudinal Swedish real-world cohort study comparing a modified Lupus Low Disease Activity State (LLDAS) using a prednisone-equivalent threshold ≤5 mg/day (LLDAS-5) vs conventional LLDAS using a ≤7.5 mg/day threshold (LLDAS-7.5) in 332 patients with systemic lupus erythematosus (SLE) were published in RMD Open by Parodis et al. The aim of this study was to compare the association between time spent in LLDAS-5 vs LLDAS-7.5 and disease worsening in the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI).

Key data: In the crude model, the association between longer time in LLDAS and a lower annual rate of SDI damage appeared more pronounced with LLDAS-5 (rate ratio [RR], 0.61; 95% confidence interval [CI], 0.37–1.00; p = 0.052) vs LLDAS-7.5 (RR, 0.73; 95% CI, 0.39–1.37; p = 0.332), with LLDAS-5 showing slightly better model fit than LLDAS-7.5. However, in multivariable analyses, both LLDAS-5 (RR, 0.56; 95% CI, 0.37–0.86; p = 0.007) and LLDAS-7.5 (RR, 0.47; 95% CI, 0.27–0.85; p = 0.012) were associated with lower damage accrual, with similar model fit. Among 105 incident cases, both definitions showed strong inverse associations with damage accrual (LLDAS-5: RR, 0.31; 95% CI, 0.11–0.89; p = 0.029; LLDAS-7.5: RR, 0.29; 95% CI, 0.09–0.93; p = 0.036).

Key learning: The study findings support LLDAS-5 as a clinically meaningful, guideline-concordant treatment target that prioritizes glucocorticoid minimization; however, the incremental prognostic value of LLDAS-5 over conventional LLDAS-7.5 requires confirmation in larger studies.