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| Dr Vera Golder |
Systematic lupus erythematosus, or lupus, is a chronic multi-organ
autoimmune disease with a broad spectrum of symptoms. Currently there are no
effective targeted treatments for lupus, and most patients are treated with
long-term steroids and therapies to suppress the immune system. While these treatments can manage disease
symptoms, they don’t prevent morbidity and loss of life expectancy and have
significant and often devastating side-effects.
“Treat-to-Target” (T2T) is a concept used to design the best
treatment options for a number of debilitating diseases, including rheumatoid
arthritis, vascular medicine and diabetes.
An international initiative that has resulted in significant
improvements in patient outcomes in many areas of medicine, T2T defines
specific treatment targets to measure disease severity.
The T2T philosophy requires information about disease
activity. But how can you hit your target if the target hasn’t been
defined? Until now, lupus has had no defined treatment
outcome states, clear treatment guidelines or T2T approaches.
“Determination of a measure of low disease activity for
lupus is a major research priority,” said Dr Vera Golder, rheumatologist at
Monash Health and PhD student in the Lupus and Arthritis Research Group, Monash
University.
“Some patients with lupus have periods of disease inactivity
punctuated by disease flare while others have persistently active disease.”
Dr Golder said that current instruments used to measure
disease activity are complex, contributing to mixed results in trialling
possible new targeted therapies.
The Asia-Pacific Lupus Collaboration recently developed and
retrospectively validated the Lupus Low Disease Activity State (LLDAS)
definition—a state which if sustained, is associated with good long-term
outcomes.
“Our study is the first to prospectively validate and refine
this LLDAS definition in a large multi-centre cohort over several years,” said
Dr Golder.
Commencing in May 2013, 1846 patients were recruited
prospectively in 12 centres from nine countries.
“In this study cohort, 93% of patients were female, with a
mean age of 29 years at diagnosis and mean disease duration of 8.5 years at the
time of recruitment.”
“More than 50% of patients were of Chinese ethnicity, 7% of
patients were Caucasian, with the remainder representing the other ethnic
groups native to the region.”
The Monash study found that Asian patients are more likely
to have renal disease, whereas Caucasian patients are more likely to exhibit
musculoskeletal, neurological and skin problems. Low disease activity was observed in less
than half of lupus patients at a single point in time.
“We’ve also shown that disease duration and phenotype, as
well as national social wealth were predictors of LLDAS attainment,” said Dr
Golder.
“Previous retrospective studies have shown that patients who
spent more than 50% 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.”
May 10 is World Lupus Day.
