Defining a low disease activity state in lupus will lead to improved outcomes for patients

School of Clinical Sciences at Monash Health lecturer and PhD candidate Dr Vera Golder was given the highest accolade at last month’s American College of Rheumatology scientific meeting in Chicago, presenting her ground-breaking research into lupus as a plenary presentation.

Dr Golder, who is also a Monash Health rheumatologist, was selected from more than 6000 submissions to present her work on a ‘Prospective Multicenter Validation Study of the Lupus Low Disease Activity State - a Treatment Target for Systemic Lupus Erythematosus’.

A chronic disease with no cure, Systemic Lupus Erythematosus (or lupus) is an autoimmune disease that mainly affects young women.

Dr Golder’s research is focused on defining and validating the Lupus Low Disease Activity State (LLDAS) in order to best manage the treatment of patients.

“The adoption of treat to target strategies have changed the approach to management of chronic diseases such as diabetes mellitus and rheumatoid arthritis,” Dr Golder said.

“Clinical targets or endpoints for treatment can represent laboratory markers, such as blood sugar levels in diabetes, or describe target disease activity states, such as remission in rheumatoid arthritis.”
Lupus, however, is a complex multi-organ disease with widely varied presentations, so desired clinical target states are difficult to define and no single laboratory test can adequately measure treatment response.

Dr Golder said that remission in lupus is difficult to achieve, but a low disease activity state may be more attainable, whist still being associated with less disease flares as well as prevention of irreversible end organ damage.

“The Asia Pacific Lupus Collaboration (APLC), an international collaboration of expert lupus clinicians and researchers including Monash University and Monash Health, has undertaken a large multinational prospective cohort study to define and validate the LLDAS as a treatment target for lupus,” Dr Golder said.

“The APLC followed 1,735 SLE patients for a mean of 2.2 years, totalling 12,717 patient visits, making this one of the largest SLE cohorts in the world.”

“LLDAS was achieved in just over half of all visits (55%), with the majority of patients (78%) being able to attain LLDAS on at least one occasion, demonstrating the feasibility of LLDAS as treatment target in routine clinical practice.”

Dr Golder and the team found that attainment of LLDAS at a single visit resulted in a 35% reduction in subsequent visit flares, and almost halving of subsequent damage, compared to patients not in LLDAS, thus validating LLDAS as a treatment target for SLE.

“The implication of our findings is that the LLDAS is an attainable and sustainable clinical treatment target for lupus patients,” Dr Golder said.

“Aiming to achieve and maintain LLDAS in clinical practice has the potential to vastly improve outcomes for lupus patients, and use of LLDAS as an end-point in clinical trials may change the landscape of available therapies.”

Dr Golder said the opportunity to present to such a large international audience is the highlight of her research career so far, and on a professional level allowed her to make important connections with world leaders in the field.

She added that none of this work would have been possible without the investigators of the APLC.

“The idea for LLDAS was the brainchild of Professor Eric Morand, who continues to lead the APLC in our research endeavours,” she said.