scholarly journals 218 Therapeutic trajectories following high disease activity state in SLE

2019 ◽  
Author(s):  
Christopher McMaster ◽  
Hieu Nim ◽  
Rachel Koelmeyer ◽  
Albert Frauman ◽  
Eric Morand ◽  
...  
Keyword(s):  
Disease Activity ◽  
High Disease Activity ◽  
Activity State ◽  
Therapeutic Trajectories

scholarly journals Attainment of treat-to-target endpoints in SLE patients with high disease activity in the atacicept phase 2b ADDRESS II study

Rheumatology ◽  
2020 ◽  
Vol 59 (10) ◽  
pp. 2930-2938 ◽  
Author(s):  
Eric F Morand ◽  
David A Isenberg ◽  
Daniel J Wallace ◽  
Amy H Kao ◽  
Cristina Vazquez-Mateo ◽  
...  
Keyword(s):  
Disease Activity ◽  
B Lymphocyte ◽  
High Disease Activity ◽  
Treat To Target ◽  
Low Disease Activity ◽  
Post Hoc Analysis ◽  
Disease Outcomes ◽  
B Lymphocyte Stimulator ◽  
Activity State ◽  
Post Hoc

Abstract Objective Low disease activity (LDA) and remission are emerging treat-to-target (T2T) endpoints in SLE. However, the rates at which these endpoints are met in patients with high disease activity (HDA) are unknown. Atacicept, which targets B lymphocyte stimulator and a proliferation-inducing ligand, improved disease outcomes in SLE patients with HDA (SLEDAI-2K ≥10) at baseline in the phase 2b ADDRESS II study. This is a post hoc analysis of T2T endpoints in these patients. Methods Patients received weekly atacicept (75 or 150 mg s.c.) or placebo for 24 weeks (1:1:1 randomization). Attainment of three T2T endpoints, LDA (SLEDAI-2K ≤ 2), Lupus Low Disease Activity State (LLDAS) and remission (clinical SLEDAI-2K = 0, prednisone-equivalent ≤5mg/day and Physician’s Global Assessment <0.5), was assessed and compared with SLE Responder Index (SRI)-4 and SRI-6 response. Results Of 306 randomized patients, 158 (51.6%) had baseline HDA. At week 24, 37 (23.4%) HDA patients attained LDA, 25 (15.8%) LLDAS and 17 (10.8%) remission. Each of these endpoints was more stringent than SRI-4 (n = 87; 55.1%) and SRI-6 (n = 67; 42.4%). Compared with placebo (n = 52), at week 24, patients treated with atacicept 150 mg (n = 51) were more likely to attain LDA [odds ratio (OR) 3.82 (95% CI: 1.44, 10.15), P = 0.007], LLDAS [OR 5.03 (95% CI: 1.32, 19.06), P = 0.018] or remission [OR 3.98 (95% CI: 0.78, 20.15), P = 0.095]. Conclusion At week 24, LDA, LLDAS and remission were more stringent than SRI-4 and SRI-6 response, were attainable in the HDA population and discriminated between treatment with atacicept 150 mg and placebo. These results suggest that T2T endpoints are robust outcome measures in SLE clinical trials and support further evaluation of atacicept in SLE. Trail registration ClinicalTrials.gov, http://clinicaltrials.gov, NCT01972568.

scholarly journals Disease course following High Disease Activity Status revealed patterns in SLE

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Alberta Hoi ◽  
Rachel Koelmeyer ◽  
Julie Bonin ◽  
Ying Sun ◽  
Amy Kao ◽  
...  
Keyword(s):  
Disease Activity ◽  
Total Duration ◽  
Clinic Visit ◽  
High Disease Activity ◽  
Disease Course ◽  
Limited Information ◽  
Low Disease Activity ◽  
Disease Patterns ◽  
Damage Accrual ◽  
Activity State

Abstract Background We sought to examine the disease course of High Disease Activity Status (HDAS) patients and their different disease patterns in a real-world longitudinal cohort. Disease resolution till Lupus Low Disease Activity State (LLDAS) has been a general treatment goal, but there is limited information on this subset of patients who achieve this. Methods All consenting patients of the Monash Lupus Cohort who had at least 12 months of observation were included. HDAS was defined as SLEDAI-2K ≥ 10 ever, and HDAS episode as the period from the first HDAS clinic visit until attainment of LLDAS. We examined the associations of different HDAS patterns with the likelihood of damage accrual. Results Of 342 SLE patients, 151 experienced HDAS at least once, accounting for 298 HDAS episodes. The majority of HDAS patients (76.2%) experienced Recurrent HDAS (> 1 HDAS visit), and a smaller subset (47.7%) had Persistent HDAS (consecutive HDAS visits for longer than 2 months). Recurrent or Persistent HDAS patients were younger at diagnosis and more likely to experience renal or serositis manifestations; persistent HDAS patients were also more likely to experience neurological manifestations. Baseline SLEDAI greater than 10 was associated with longer HDAS episodes. Recurrent and Persistent HDAS were both associated with an increased likelihood of damage accrual. The total duration of HDAS episode greater than 2 years and experiencing multiple HDAS episodes (≥4) was also associated with an increased likelihood of damage accrual (OR 1.80, 95% CI 1.08–2.97, p = 0.02, and OR 3.31, 95% CI 1.66–13.26, p = 0.01, respectively). Conclusion HDAS episodes have a highly variable course. Recurrent and Persistent HDAS, and longer duration of HDAS episodes, increased the risk of damage accrual. In addition to a major signifier of severity in SLE, its resolution to LLDAS can determine the subsequent outcome in SLE patients.

scholarly journals Disease Course Following High Disease Activity Status Revealed Patterns in SLE

2021 ◽  
Author(s):  
Alberta Hoi ◽  
Rachel Koelmeyer ◽  
Julie Bonin ◽  
Ying Sun ◽  
Amy Kao ◽  
...  
Keyword(s):  
Disease Activity ◽  
Total Duration ◽  
Clinic Visit ◽  
High Disease Activity ◽  
Disease Course ◽  
Limited Information ◽  
Disease Patterns ◽  
Increased Risk ◽  
Damage Accrual ◽  
Activity State

Abstract Background: We sought to examine the disease course of High Disease Activity Status (HDAS) patients and their different disease patterns in a real-world longitudinal cohort. Disease resolution till Lupus Low Disease Activity State (LLDAS) has been a general treatment goal, but there is limited information on this subset of patients who achieve this.Methods: All consenting patients of the Monash Lupus Cohort who had at least 12 months of observation were included. HDAS was defined as SLEDAI-2K³10 ever, and HDAS episode as the period from the first HDAS clinic visit until attainment of LLDAS. We examined the associations of different HDAS patterns with the likelihood of damage accrual. Results: Of 342 SLE patients, 151 experienced HDAS at least once, accounting for 298 HDAS episodes. The majority of HDAS patients (76∙2%) experienced Recurrent HDAS (>1 HDAS visit), and a smaller subset (47∙7%) had Persistent HDAS (consecutive HDAS visits for longer than 2 months. Recurrent or Persistent HDAS patients were younger at diagnosis and more likely to experience renal or serositis manifestations; persistent HDAS patients were also more likely to experience neurological manifestations. Baseline SLEDAI greater than 10 was associated with longer HDAS episodes. Recurrent or Persistent HDAS were both associated with an increased likelihood of damage accrual. Total duration of HDAS episode greater than 2 years and experiencing multiple HDAS episodes (>4) were also associated with an increased likelihood of damage accrual (OR 1∙80, 95%CI 1∙08 - 2∙97, p=0∙02, and OR 3∙31, 95% CI 1∙66-13∙26, p=0∙01 respectively).Conclusion: HDAS episodes have a highly variable course. Recurrent and Persistent HDAS, and longer duration of HDAS episodes, increased risk of damage accrual. In addition to a major signifier of severity in SLE, its resolution to LLDAS can determine subsequent outcome in SLE patients.

Is Treat-to-target in Lupus Nephritis Realistic in Clinical Practice?

2018 ◽  
Vol 15 (1) ◽  
pp. 2-6 ◽  
Author(s):  
Chi Chiu Mok
Keyword(s):  
Lupus Nephritis ◽  
Disease Activity ◽  
Safety Concern ◽  
Real Life ◽  
Current Treatment ◽  
Treat To Target ◽  
Low Disease Activity ◽  
Activity State ◽  
Definition Of ◽  
Comparative Trials

The Treat-to-Target (T2T) principle has been advocated in a number of inflammatory and non-inflammatory medical illnesses. Tight control of disease activity has been shown to improve the outcome of rheumatoid arthritis and psoriatic arthritis as compared to the conventional approach. However, whether T2T can be applied to patients with lupus nephritis is still under emerging discussion. Treatment of lupus nephritis should target at inducing and maintaining remission of the kidney inflammation so as to preserve renal function and improve survival in the longterm. However, there is no universal agreement on the definition of remission or low disease activity state of nephritis, as well as the time points for switching of therapies. Moreover, despite the availability of objective parameters for monitoring such as proteinuria and urinary sediments, differentiation between ongoing activity and damage in some patients with persistent urinary abnormalities remains difficult without a renal biopsy. A large number of serum and urinary biomarkers have been tested in lupus nephritis but none of them have been validated for routine clinical use. In real life practice, therapeutic options for lupus nephritis are limited. As patients with lupus nephritis are more prone to infective complications, tight disease control with aggressive immunosuppressive therapies may have safety concern. Not until the feasibility, efficacy, safety and cost-effectiveness of T2T in lupus nephritis is confirmed by comparative trials, this approach should not be routinely recommended with the current treatment armamentarium and monitoring regimes.

Sign in / Sign up

Export Citation Format

Share Document