Monash researchers identify attainable treatment target for lupus patients

Dr Vera Golder 

For the first time, Monash researchers have identified an attainable treatment target for systemic lupus erythematosus – also known as SLE or lupus – called Lupus Low Disease Activity State (LLDAS), which has shown to be associated with a significant reduction in irreversible end organ damage – a factor that contributes to premature death in patients.

Lupus is a complex multisystem autoimmune disease predominantly affecting women of childbearing age. It can cause inflammation and result in irreversible damage in any organ system ranging from skin and joints to life threatening disease of the kidneys or central nervous system. Whilst not common, people with lupus have a 12 percent chance of dying within 20 years of diagnosis.

Unlike other chronic diseases, such as diabetes and rheumatoid arthritis, where treatments have been easily measurable, treatment of more complex multi-organ conditions such as lupus have been much harder to define. Without a clearly defined or readily attainable goal of therapy, treatment has been comparable to shooting an arrow in the dark or aiming at a target so small it would be impossible to hit. SCS researcher, Dr Vera Golder, says LLDAS provides a target that is both easy to see (understand) and easy to hit (achieve).

The ‘world-first’ study, in which Dr Golder and Professor Eric Morand were lead authors, was undertaken in collaboration with the Asia Pacific Lupus Collaboration – a network of expert lupus clinicians and researchers whose aim is to research treatment outcomes for systemic lupus erythematosus. Investigators in 13 centres from eight countries in the Asia Pacific region followed 1,735 lupus patients for an average of 2.2 years, totalling 12,717 patient visits.

“As part of the validation process we studied the association of attaining LLDAS with subsequent damage accrual, and were able to demonstrate that patients who were able to attain LLDAS, even for a short period of time, had significant protection from irreversible end organ damage. Moreover, the protective effect of LLDAS increased with time in a dose dependent relationship, such that patients who spent 12 months in LLDAS had an almost 90 percent reduction in risk of end organ damage." Dr Golder said.

The findings show that LLDAS is an attainable and sustainable clinical treatment target for lupus patients that has been associated with reduced disease flares and end organ damage.

According to Dr Golder, achieving and maintaining LLDAS in clinical practice has the potential to significantly improve outcomes for lupus patients, and use of LLDAS as an end-point in clinical trials may change the landscape of available therapies.

The findings of the study have been published in The Lancet Rheumatology.