Treat-to-Target Study Identifies Possible Markers for Low Disease Activity in Lupus Patients

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by Margarida Azevedo |

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Findings from a large “Treat-to-Target” (T2T) study of systemic lupus erythematosus (SLE), focusing on patient and disease characteristics, and factors influencing a low disease activity state — associated with better long-term outcomes —  were presented at the recent  Australian Rheumatology Association Annual Scientific Meeting in Darwin.

Treat-to-Target (T2T), an approach used for the design of the best treatment options in a number of diseases, defines specific treatment targets to measure disease activity. Its use has resulted in significant improvements in patient outcomes in many disease areas.

SLE or lupus, a chronic autoimmune disease, has no specific targeted treatments available (current treatments are long-term steroids or medicines to suppress the immune system). Furthermore, the disease has no defined treatment outcome states, precise treatment guidelines or T2T approaches, such as measures of disease activity. One of the main priorities of the study was to determine a measure low disease activity for lupus. But lupus varies greatly from patient to patient, with some having periods of disease inactivity interrupted by flares, and others with continuous disease activity.

According to  Dr. Vera Golder, a rheumatologist at Monash Health and PhD student in the Lupus and Arthritis Research Group at Monash University, who presented the study’s findings, current measures of diseases activity are complex and often lead to mixed results in trials investigating new therapeutic targets.

Dr. Golder and colleagues sought to validate and refine the Lupus Low Disease Activity State (LLDAS) definition, a concept developed and previously validated by the Asia-Pacific Lupus Collaboration. The study, which began in May 2013, recruited 1,846 patients at 12 centers in nine countries. Most patients (93 percent) were female, with a mean age of 29 at diagnosis and mean disease duration of 8.5 years at the time of recruitment. Fifty percent of the patients were of Chinese ethnicity, 7  percent were Caucasian, and the remainder belonged to other ethnic groups.

Asian patients were more likely to have renal disease, while Caucasians tended to show musculoskeletal, neurological, and skin symptoms. At a single point in time, low disease activity was seen in less than half of the lupus patients.

“We’ve also shown that disease duration and phenotype, as well as national social wealth were predictors of LLDAS attainment,” Dr. Golder said in a press release. “Previous retrospective studies have shown that patients who spent more than 50 per cent of their disease duration in LLDAS accrued less damage compared to patients who did not. We are hopeful our study has brought us a step closer identifying treatment options that will have better long-term outcomes for lupus patients.”

The findings will also be presented at the European League Against Rheumatism Annual Scientific Meeting in London, set for June 8–11.