Validation of childhood lupus specific targets: ensuring accurate assessment of disease control in younger, lighter paediatric patients.
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Authors
Sarker, Chandni
Jorgensen, Andrea L
Tharmaratnam, Kukatharmini
Al-Abadi, Eslam
Armon, Kate
Bailey, Kathryn
Bohm, Marek
Brennan, Mary
Ciurtin, Coziana
Gardner-Medwin, Janet
Issue Date
2025-06-01
Type
Journal Article
Validation Study
Validation Study
Language
en
Keywords
T2T , cSLE , childhood-SLE , low disease activity , remission , treat-to-target
Alternative Title
Abstract
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.
Description
© The Author(s) 2025. Published by Oxford University Press on behalf of the British Society for Rheumatology.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Citation
Sarker, C. et al. (2025) 'Validation of childhood lupus specific targets: ensuring accurate assessment of disease control in younger, lighter paediatric patients', Rheumatology 64(6) pp. 3587-3597. Available at: https://doi.org/10.1093/rheumatology/keaf057
Publisher
Oxford University Press
License
© The Author(s) 2025. Published by Oxford University Press on behalf of the British Society for Rheumatology.
Journal
Rheumatology (Oxford, England)
Volume
64
Issue
6
PubMed ID
ISSN
1462-0332