{
  "abstract": "Objectives Lupus Low Disease Activity State (LLDAS) and Definition of Remission in SLE (DORIS) are associated with improved outcomes in SLE; however, their value in lupus nephritis (LN) remains unexplored. We sought to evaluate their prognostic value on organ damage accrual, renal flares and chronic kidney disease in patients with LN.Methods Multicentre retrospective cohort study of patients with biopsy-proven LN who achieved renal response. Enrolment date was the time of first renal response. Longitudinal data were analysed using Cox proportional hazards models. Modified LLDAS (mLLDAS) and DORIS (mDORIS) attainment and sustained durations were evaluated.Results 155 patients with 1703 visits were included. During a median follow-up of 3.5 years (IQR 4.5), 127 patients (81.9%) achieved mLLDAS and 92 (59.4%) achieved mDORIS. Both states demonstrated robust protective effects across all outcomes. For organ damage, mLLDAS attainment was associated with 85% risk reduction (adjusted HR (aHR 0.15, 95% CI 0.07 to 0.32), while mDORIS conferred a 79% reduction (aHR 0.21, 95% CI 0.08 to 0.55). Periods under mLLDAS were also associated with a 73% reduction in renal flare risk (aHR 0.27, 95% CI 0.14 to 0.51), with similar effects for mDORIS. Sustained achievement resulted in progressively greater protection, with the strongest effects seen for ≥24 consecutive months. Early attainment protected against damage accrual (aHR 0.31, 95% CI 0.16 to 0.61) and renal flares (aHR 0.51, 95% CI 0.29 to 1.00).Conclusions Following renal response, achievement of mLLDAS and mDORIS is strongly associated with improved outcomes in LN patients. Earlier attainment and longer duration in these states confer progressively greater protection.",
  "authors": [
    {
      "affiliations": [
        "Rheumatology and Clinical Immunology Unit, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece"
      ],
      "name": "Konstantinos Drougkas"
    },
    {
      "affiliations": [
        "Rheumatology and Clinical Immunology Unit, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece"
      ],
      "name": "Spyridon Katechis"
    },
    {
      "affiliations": [
        "Department of Nephrology, \"G. Gennimatas” General Hospital, Athens, Greece"
      ],
      "name": "Myrto Kostopoulou"
    },
    {
      "affiliations": [
        "Clinical Immunology- Rheumatology Unit, 2nd Department of Medicine and Laboratory, General Hospital of Athens Hippokration, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece"
      ],
      "name": "Christina Tsalapaki"
    },
    {
      "affiliations": [
        "Rheumatology and Clinical Immunology Unit, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece"
      ],
      "name": "Sofia Flouda"
    },
    {
      "affiliations": [
        "Rheumatology and Clinical Immunology Unit, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece"
      ],
      "name": "Maria Pappa"
    },
    {
      "affiliations": [
        "Division of Clinical Immunology and Rheumatology, Croatian Referral Centre for SLE and Related Diseases, Department of Internal Medicine, University Hospital Centre Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia"
      ],
      "name": "Marija Bakula"
    },
    {
      "affiliations": [
        "Division of Clinical Immunology and Rheumatology, Croatian Referral Centre for SLE and Related Diseases, Department of Internal Medicine, University Hospital Centre Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia"
      ],
      "name": "Ivan Padjen"
    },
    {
      "affiliations": [
        "Rheumatology, Clinical Immunology and Allergy Department, University Hospital of Heraklion, University of Crete, School of Medicine, Heraklion, Greece"
      ],
      "name": "Myrto Nikoloudaki"
    },
    {
      "affiliations": [
        "Department of Rheumatology, \"G. Gennimatas” General Hospital, Athens, Greece"
      ],
      "name": "Pinelopi Konstantopoulou"
    },
    {
      "affiliations": [
        "Department of Nephrology, \"G. Gennimatas” General Hospital, Athens, Greece"
      ],
      "name": "George Moustakas"
    },
    {
      "affiliations": [
        "Clinical Immunology- Rheumatology Unit, 2nd Department of Medicine and Laboratory, General Hospital of Athens Hippokration, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece"
      ],
      "name": "Dimitrios Vassilopoulos"
    },
    {
      "affiliations": [
        "Rheumatology, Clinical Immunology and Allergy Department, University Hospital of Heraklion, University of Crete, School of Medicine, Heraklion, Greece"
      ],
      "name": "George Bertsias"
    },
    {
      "affiliations": [
        "Department of Rheumatology, University of Ioannina, Faculty of Medicine, Ioannina, Greece"
      ],
      "name": "Paraskevi V Voulgari"
    },
    {
      "affiliations": [
        "Rheumatology and Clinical Immunology Unit, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece"
      ],
      "name": "Dimitrios T Boumpas"
    },
    {
      "affiliations": [
        "Rheumatology and Clinical Immunology Unit, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece"
      ],
      "name": "Antonis Fanouriakis"
    }
  ],
  "title": "Beyond renal response: sustained systemic disease control protects against adverse long-term outcomes in lupus nephritis",
  "uid": "36614748-cab3-58ee-804e-aea5be63ef0b"
}