{
  "abstract": "Objectives This study examined if lowering the glucocorticoid (GC) ceiling in the definition of lupus low disease activity state (LLDAS) from 7.5 mg/day to 5 mg/day (LLDAS-5) was associated with better outcomes in patients with systemic lupus erythematosus (SLE).Methods Data from a 13-country longitudinal SLE cohort (American College of Rheumatology/Systemic Lupus International Collaborating Clinics criteria), collected prospectively between 2013 and 2020, were analysed. Survival analyses were used to examine the longitudinal associations of LLDAS definitions with flare, organ damage accrual (frailty models) and mortality (Cox regression models).Results 3801 patients with ≥2 visits were studied, with a median of 2.8 years (IQR: 1.0–5.4) of follow-up data (total visits: 40 949). 2141 (56.3%) patients experienced mild–moderate/severe flares; 717 (20.8%) accrued organ damage, and 80 (2.1%) died. 3072 (80%) patients attained LLDAS in 19 293 (47%) visits, while 2858 (75%) patients attained LLDAS-5 in 17 403 (42%) visits. Most patients in LLDAS were also in LLDAS-5; 214 patients (5.6%) attained LLDAS on at least one occasion, but never attained LLDAS-5. The magnitude of protection provided by LLDAS attainment against flare, irreversible organ damage accrual and mortality was similar with both GC thresholds. HRs (95% CIs) of damage accrual subsequent to spending 12 months in sustained LLDAS and LLDAS-5 were 0.42 (0.33 to 0.54, p<0.0001) and 0.43 (0.34 to 0.55, p<0.001), respectively. Likewise, HRs of flare and mortality corresponding to 12 months in LLDAS and LLDAS-5 were similar.Conclusions No evidence was found to support revising the GC dose threshold of the LLDAS definition. Regardless, minimising GC exposure remains a key goal of SLE management.Trial registration number NCT03138941.",
  "authors": [
    {
      "affiliations": [
        "Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia"
      ],
      "name": "Rangi Kandane-Rathnayake"
    },
    {
      "affiliations": [
        "Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia",
        "Rheumatology Department, Monash Health, Clayton, Victoria, Australia"
      ],
      "name": "Alberta Hoi"
    },
    {
      "affiliations": [
        "Division of Rheumatology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand"
      ],
      "name": "Worawit Louthrenoo"
    },
    {
      "affiliations": [
        "Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia",
        "Rheumatology Department, Monash Health, Clayton, Victoria, Australia"
      ],
      "name": "Vera Golder"
    },
    {
      "affiliations": [
        "Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taichung City, Taiwan"
      ],
      "name": "Yi-Hsing Chen"
    },
    {
      "affiliations": [
        "Rheumatology Division, Department of Medicine, National University Hospital, Singapore"
      ],
      "name": "Jiacai Cho"
    },
    {
      "affiliations": [
        "Department of Medicine, Woodlands Health, Singapore"
      ],
      "name": "Aisha Lateef"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia"
      ],
      "name": "Laniyati Hamijoyo"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taipei, Taiwan"
      ],
      "name": "Shue-Fen Luo"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Keelung, Taiwan"
      ],
      "name": "Yeong-Jian Jan Wu"
    },
    {
      "affiliations": [
        "Section of Rheumatology, University of Santo Tomas Hospital, Manila, Philippines"
      ],
      "name": "Sandra Navarra"
    },
    {
      "affiliations": [
        "Section of Rheumatology, University of Santo Tomas Hospital, Manila, Philippines"
      ],
      "name": "Leonid Zamora"
    },
    {
      "affiliations": [
        "Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing, China"
      ],
      "name": "Zhanguo Li"
    },
    {
      "affiliations": [
        "Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing, China"
      ],
      "name": "Haihong Yao"
    },
    {
      "affiliations": [
        "Department of Medicine, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia"
      ],
      "name": "Sargunan Sockalingam"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan"
      ],
      "name": "Yasuhiro Katsumata"
    },
    {
      "affiliations": [
        "Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China",
        "Department of Rheumatology, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia"
      ],
      "name": "Yanjie Hao"
    },
    {
      "affiliations": [
        "Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China"
      ],
      "name": "Zhuoli Zhang"
    },
    {
      "affiliations": [
        "Department of Nephrology, Teaching Hospital Kandy, Kandy, Sri Lanka"
      ],
      "name": "B M D B Basnayake"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Allergy & Immunology, Tan Tock Seng Hospital, Singapore"
      ],
      "name": "Madelynn Chan"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Keio University, Tokyo, Japan"
      ],
      "name": "Jun Kikuchi"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Keio University, Tokyo, Japan"
      ],
      "name": "Yuko Kaneko"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Keio University, Tokyo, Japan",
        "Department of Rheumatology and Applied Immunology/Clinical Immunology, Saitama Medical University, Saitama, Japan"
      ],
      "name": "Tsutomu Takeuchi"
    },
    {
      "affiliations": [
        "Department of Rheumatology, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia"
      ],
      "name": "Shereen Oon"
    },
    {
      "affiliations": [
        "Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seongdong-gu, Seoul, Republic of Korea",
        "Hanyang University Institute of Bioscience and Biotechnology, Seongdong-gu, Seoul, Republic of Korea"
      ],
      "name": "Sang-Cheol Bae"
    },
    {
      "affiliations": [
        "Rheumatology Department, Liverpool Hospital, Liverpool, New South Wales, Australia",
        "University of Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Sean O’Neill"
    },
    {
      "affiliations": [
        "Rheumatology Department, Liverpool Hospital, Liverpool, New South Wales, Australia"
      ],
      "name": "Geraldine Hassett"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Flinders Medical Centre, Bedford Park, South Australia, Australia"
      ],
      "name": "Fiona Goldblatt"
    },
    {
      "affiliations": [
        "North Shore Hospital, Te Whatu Ora Health New Zealand Waitemata, Auckland, New Zealand"
      ],
      "name": "Kristine Pek Ling Ng"
    },
    {
      "affiliations": [
        "Department of Rheumatology and Immunology, Singapore General Hospital, Singapore"
      ],
      "name": "Yih Jia Poh"
    },
    {
      "affiliations": [
        "Greenlane Clinical Centre, Te Whatu Ora Health New Zealand Te Toka Tumai Auckland, Auckland, New Zealand"
      ],
      "name": "Nicola Tugnet"
    },
    {
      "affiliations": [
        "Middlemore Hospital, Te Whatu Ora Health New Zealand Counties Manukau, Auckland, New Zealand"
      ],
      "name": "Mark Sapsford"
    },
    {
      "affiliations": [
        "Department of Medicine, The University of Hong Kong, Pok fu lam, Hong Kong"
      ],
      "name": "Shirley Chan"
    },
    {
      "affiliations": [
        "Department of Pediatrics, College of Medicine, University of the Philippines, Manila, Philippines"
      ],
      "name": "Cherica Tee"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Rheumatology, University of the Philippines, Manila, Philippines"
      ],
      "name": "Michael Lucas Tee"
    },
    {
      "affiliations": [
        "The First Department of Internal Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, Japan"
      ],
      "name": "Naoaki Ohkubo"
    },
    {
      "affiliations": [
        "The First Department of Internal Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, Japan",
        "Department of Molecular Targeted Therapeutics, University of Occupational and Environmental Health, Kitakyushu, Japan"
      ],
      "name": "Yoshiya Tanaka"
    },
    {
      "affiliations": [
        "Department of Medicine, The University of Hong Kong, Pok fu lam, Hong Kong"
      ],
      "name": "Chak Sing Lau"
    },
    {
      "affiliations": [
        "Department of Rheumatology, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia",
        "University of Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Mandana Nikpour"
    },
    {
      "affiliations": [
        "Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia",
        "Rheumatology Department, Monash Health, Clayton, Victoria, Australia"
      ],
      "name": "Eric Morand"
    }
  ],
  "title": "Impact of glucocorticoid dose threshold in definition of lupus low disease activity state: a multinational observational cohort study",
  "uid": "149115d1-71d6-5e3b-a6b1-ed223262a331"
}