Browse by author
Lookup NU author(s): Dr Ethan SenORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2025 The Author(s).Objectives: To validate novel childhood-onset systemic lupus erythematosus (cSLE) treat-To-Target targets including childhood lupus low disease activity state (cLLDAS), cSLE clinical remission on steroids (cCR) and cSLE clinical remission off steroids (cCR-0), as compared with adult-onset SLE (aSLE) targets. Methods: Attainment of the aforementioned cSLE-specific and aSLE-specific targets (LLDAS, DORIS 2021 Remission) was assessed at each visit in UK JSLE Cohort Study patients. Univariable and multivariable Prentice-Williams-Peterson (PWP) gap-Time models investigated the impact of target attainment on new damage and severe flare. Results: The cohort included 430 cSLE patients. Attainability was comparable between corresponding cSLE and aSLE targets. Achieving cLLDAS (hazard ratio [HR] 0.18 [95% CI: 0.14, 0.23]), cCR (HR 0.18 [0.13, 0.23]) and cCR-0 (HR 0.17 [0.13, 0.23]) reduced the risk of severe flare (all P < 0.001). Risk of new damage was reduced in those reaching cLLDAS (HR 0.22 [0.11, 0.44]), cCR (HR 0.25 [0.13, 0.49]) and cCR-0 (HR 0.30 [0.15, 0.60]) (all P < 0.001). Inappropriate attainment of LLDAS and DORIS remission occurred at 35 and 52 visits, respectively, in younger (median age 7.3 and 8.8 years, respectively) and lighter (median weight 26.8 and 37.1 kg, respectively) patients whilst on prednisolone doses that precluded cSLE target attainment (median 0.17 [IQR 0.16-0.24] and 0.13 [IQR 0.11-0.16] mg/kg/day, respectively). Conclusions: This study validates novel paediatric-specific targets, demonstrating that achieving cLLDAS, cCR and cCR-0 reduces risks of new damage and severe flare, which is comparable to aSLE targets. Using cSLE-specific targets prevents misclassification of disease activity in paediatric patients, enabling more accurate disease control assessments in younger, lighter patients.
Author(s): Sarker C, Jorgensen AL, Tharmaratnam K, Al-Abadi E, Armon K, Bailey K, Bohm M, Brennan M, Ciurtin C, Gardner-Medwin J, Hawley DP, Kinder A, Leahy A, Malik G, McLaren Z, Moraitis E, Mosley E, Ramanan AV, Rangaraj S, Ratcliffe A, Riley P, Rostron H, Sen ES, Hedrich CM, Beresford MW, Smith EMD
Publication type: Article
Publication status: Published
Journal: Rheumatology
Year: 2025
Volume: 64
Issue: 6
Pages: 3587-3597
Print publication date: 01/06/2025
Online publication date: 06/02/2025
Acceptance date: 23/01/2025
Date deposited: 09/06/2025
ISSN (print): 1462-0324
ISSN (electronic): 1462-0332
Publisher: Oxford University Press
URL: https://doi.org/10.1093/rheumatology/keaf057
DOI: 10.1093/rheumatology/keaf057
Data Access Statement: Data will be made available on reasonable request
PubMed id: 39913509
Altmetrics provided by Altmetric
