PO:14:198 | Temporal Trends in LLDAS and DORIS Achievement in SLE: Impact of Evolving International Recommendations

Laura Coladonato¹, Marco Fornaro¹, Angelica Napoletano¹, Daniele Catamerò¹, Giuseppe Lopalco¹, Florenzo Iannone¹ | ¹UOC Reumatologia, Policlinico di Bari, DiMePre-J Bari, Italy

Objective To evaluate the evolution of disease outcomes, specifically the achievement of Lupus Low Disease Activity State (LLDAS) according to the 2019 and 2023 definitions, and the Definition of Remission in SLE (DORIS), in patients with Systemic Lupus Erythematosus (SLE) over time, in relation to the implementation of international recommendations published before 2019, before 2023, and after 2023.

Materials and Methods. We conducted a retrospective analysis of 110 patients diagnosed with SLE, each with a minimum follow-up duration of 6 months. Clinical data were stratified into three time frames: Pre-2019, Pre-2023, and Post-2023, corresponding to the publication of updated international treatment guidelines. We evaluated the proportion of patients achieving LLDAS (according to both the 2019 and 2023 definitions) and DORIS remission at visits occurring prior to 2019, prior to 2023, and at the most recent visit after 2023, in alignment with the timing of these recommendations. Additionally, we analyzed longitudinal trends in corticosteroid use (prednisone-equivalent dose), Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2K), and Systemic Lupus International Collaborating Clinics Damage Index (SDI). Statistical significance was set at p<0.05. Definition of Remission (DORIS) • Clinical SLEDAI-2K = 0 (excluding serology), • Physician Global Assessment (PGA) < 0.5, • Stable use of antimalarials and immunosuppressants is allowed, • Glucocorticoids must be l.e. 5 mg/day LLDAS Definitions • LLDAS 2019: SLEDAI-2K l.e. 4 (excluding major organ involvement), no new clinical activity, PGA l.e. 1, and prednisone dose l.e. 7.5 mg/day. • LLDAS 2023: SLEDAI-2K l.e. 4 (excluding renal, CNS, and vasculitis activity), PGA l.e. 1, and corticosteroids l.e. 5 mg/day.

Results. The percentage of patients achieving LLDAS (2019 definition) increased slightly over time: 74% in Pre-2019, 75% in Pre-2023, and 77% in Post-2023. LLDAS 2023 achievement rose more substantially from 66% to 75%. DORIS remission showed the most marked improvement, from 51% to 67% (p<0.05 between Pre-2019 and Post-2023) (Figure 1A). Mean (SD) prednisone use declined significantly from mean (SD) 4.7 (4.1) mg/day to 2.4 (3.3) mg/day (p<0.05). SLEDAI showed a modest decrease, while mean (SD) SDI increased slightly from 0.9 (1.4) to 1.2 (1.7). Notably, patients who discontinued corticosteroids exhibited significantly less SDI progression (Figure 1B, p<0.05). Steroid exposure correlated positively with SDI (r = 0.324, p = 0.001) and SLEDAI-2K (r = 0.311, p = 0.001), while no direct correlation was found between SLEDAI-2K and SDI.

Conclusions. Our findings highlight a temporal improvement in disease control among SLE patients, as evidenced by increasing rates of LLDAS and DORIS remission, likely influenced by evolving international treatment guidelines. Achieving steroid-free status emerged as a critical factor in preventing long-term organ damage, underscoring the importance of glucocorticoid minimization. These results support the integration of treat-to-target strategies and steroid withdrawal as a key therapeutic objective in routine SLE management.