A framework for remission in SLE: consensus findings from a large international task force on definitions of remission in SLE (DORIS)

Ronald van Vollenhoven; Alexandre Voskuyl; George Bertsias; Cynthia Aranow; Martin Aringer; Laurent Arnaud; Anca Askanase; Petra Balážová; Eloisa Bonfa; Hendrika Bootsma; Dimitrios Boumpas; Ian Bruce; Ricard Cervera; Ann Clarke; Cindy Coney; Nathalie Costedoat-Chalumeau; László Czirják; Ronald Derksen; Andrea Doria; Thomas Dörner; Rebecca Fischer-Betz; Ruth Fritsch-Stork; Caroline Gordon; Winfried Graninger; Noémi Györi; Frédéric Houssiau; David Isenberg; Soren Jacobsen; David Jayne; Annegret Kuhn; Veronique Le Guern; Kirsten Lerstrøm; Roger Levy; Francinne Machado-Ribeiro; Xavier Mariette; Jamil Missaykeh; Eric Morand; Marta Mosca; Murat Inanc; Sandra Navarra; Irmgard Neumann; Marzena Olesinska; Michelle Petri; Anisur Rahman; Ole Petter Rekvig; Jozef Rovensky; Yehuda Shoenfeld; Josef Smolen; Angela Tincani; Murray Urowitz; Bernadette van Leeuw; Carlos Vasconcelos; Anne Voss; Victoria P Werth; Helena Zakharova; Asad Zoma; Matthias Schneider; Michael Ward

doi:10.1136/annrheumdis-2016-209519

A framework for remission in SLE: consensus findings from a large international task force on definitions of remission in SLE (DORIS)

Ronald van Vollenhoven, Alexandre Voskuyl, George Bertsias, Cynthia Aranow, Martin Aringer, Laurent Arnaud, Anca Askanase, Petra Balážová, Eloisa Bonfa, Hendrika Bootsma, Dimitrios Boumpas, Ian Bruce, Ricard Cervera, Ann Clarke, Cindy Coney, Nathalie Costedoat-Chalumeau, László Czirják, Ronald Derksen, Andrea Doria, Thomas DörnerRebecca Fischer-Betz, Ruth Fritsch-Stork, Caroline Gordon, Winfried Graninger, Noémi Györi, Frédéric Houssiau, David Isenberg, Soren Jacobsen, David Jayne, Annegret Kuhn, Veronique Le Guern, Kirsten Lerstrøm, Roger Levy, Francinne Machado-Ribeiro, Xavier Mariette, Jamil Missaykeh, Eric Morand, Marta Mosca, Murat Inanc, Sandra Navarra, Irmgard Neumann, Marzena Olesinska, Michelle Petri, Anisur Rahman, Ole Petter Rekvig, Jozef Rovensky, Yehuda Shoenfeld, Josef Smolen, Angela Tincani, Murray Urowitz, Bernadette van Leeuw, Carlos Vasconcelos, Anne Voss, Victoria P Werth, Helena Zakharova, Asad Zoma, Matthias Schneider, Michael Ward

Department for Rheumatology and Spine Diseases

329 Citations (Scopus)

Abstract

OBJECTIVES: Treat-to-target recommendations have identified 'remission' as a target in systemic lupus erythematosus (SLE), but recognise that there is no universally accepted definition for this. Therefore, we initiated a process to achieve consensus on potential definitions for remission in SLE.

METHODS: An international task force of 60 specialists and patient representatives participated in preparatory exercises, a face-to-face meeting and follow-up electronic voting. The level for agreement was set at 90%.

RESULTS: The task force agreed on eight key statements regarding remission in SLE and three principles to guide the further development of remission definitions:1. Definitions of remission will be worded as follows: remission in SLE is a durable state characterised by …………………. (reference to symptoms, signs, routine labs).2. For defining remission, a validated index must be used, for example, clinical systemic lupus erythematosus disease activity index (SLEDAI)=0, British Isles lupus assessment group (BILAG) 2004 D/E only, clinical European consensus lupus outcome measure (ECLAM)=0; with routine laboratory assessments included, and supplemented with physician's global assessment.3. Distinction is made between remission off and on therapy: remission off therapy requires the patient to be on no other treatment for SLE than maintenance antimalarials; and remission on therapy allows patients to be on stable maintenance antimalarials, low-dose corticosteroids (prednisone ≤5 mg/day), maintenance immunosuppressives and/or maintenance biologics.The task force also agreed that the most appropriate outcomes (dependent variables) for testing the prognostic value (construct validity) of potential remission definitions are: death, damage, flares and measures of health-related quality of life.

CONCLUSIONS: The work of this international task force provides a framework for testing different definitions of remission against long-term outcomes.

Original language	English
Journal	Annals of the Rheumatic Diseases
Volume	76
Issue number	3
Pages (from-to)	554-561
Number of pages	8
ISSN	0003-4967
DOIs	https://doi.org/10.1136/annrheumdis-2016-209519
Publication status	Published - Mar 2017

Keywords

Adrenal Cortex Hormones
Antibodies, Antinuclear
Antimalarials
Complement System Proteins
Consensus
DNA
Humans
Immunosuppressive Agents
Lupus Erythematosus, Systemic
Maintenance Chemotherapy
Remission Induction
Severity of Illness Index
Symptom Flare Up
Consensus Development Conference
Journal Article
Review

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van Vollenhoven, R., Voskuyl, A., Bertsias, G., Aranow, C., Aringer, M., Arnaud, L., Askanase, A., Balážová, P., Bonfa, E., Bootsma, H., Boumpas, D., Bruce, I., Cervera, R., Clarke, A., Coney, C., Costedoat-Chalumeau, N., Czirják, L., Derksen, R., Doria, A., ... Ward, M. (2017). A framework for remission in SLE: consensus findings from a large international task force on definitions of remission in SLE (DORIS). Annals of the Rheumatic Diseases, 76(3), 554-561. https://doi.org/10.1136/annrheumdis-2016-209519

van Vollenhoven, R, Voskuyl, A, Bertsias, G, Aranow, C, Aringer, M, Arnaud, L, Askanase, A, Balážová, P, Bonfa, E, Bootsma, H, Boumpas, D, Bruce, I, Cervera, R, Clarke, A, Coney, C, Costedoat-Chalumeau, N, Czirják, L, Derksen, R, Doria, A, Dörner, T, Fischer-Betz, R, Fritsch-Stork, R, Gordon, C, Graninger, W, Györi, N, Houssiau, F, Isenberg, D, Jacobsen, S, Jayne, D, Kuhn, A, Le Guern, V, Lerstrøm, K, Levy, R, Machado-Ribeiro, F, Mariette, X, Missaykeh, J, Morand, E, Mosca, M, Inanc, M, Navarra, S, Neumann, I, Olesinska, M, Petri, M, Rahman, A, Rekvig, OP, Rovensky, J, Shoenfeld, Y, Smolen, J, Tincani, A, Urowitz, M, van Leeuw, B, Vasconcelos, C, Voss, A, Werth, VP, Zakharova, H, Zoma, A, Schneider, M & Ward, M 2017, 'A framework for remission in SLE: consensus findings from a large international task force on definitions of remission in SLE (DORIS)', Annals of the Rheumatic Diseases, vol. 76, no. 3, pp. 554-561. https://doi.org/10.1136/annrheumdis-2016-209519

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title = "A framework for remission in SLE: consensus findings from a large international task force on definitions of remission in SLE (DORIS)",

abstract = "OBJECTIVES: Treat-to-target recommendations have identified 'remission' as a target in systemic lupus erythematosus (SLE), but recognise that there is no universally accepted definition for this. Therefore, we initiated a process to achieve consensus on potential definitions for remission in SLE.METHODS: An international task force of 60 specialists and patient representatives participated in preparatory exercises, a face-to-face meeting and follow-up electronic voting. The level for agreement was set at 90\%.RESULTS: The task force agreed on eight key statements regarding remission in SLE and three principles to guide the further development of remission definitions:1. Definitions of remission will be worded as follows: remission in SLE is a durable state characterised by …………………. (reference to symptoms, signs, routine labs).2. For defining remission, a validated index must be used, for example, clinical systemic lupus erythematosus disease activity index (SLEDAI)=0, British Isles lupus assessment group (BILAG) 2004 D/E only, clinical European consensus lupus outcome measure (ECLAM)=0; with routine laboratory assessments included, and supplemented with physician's global assessment.3. Distinction is made between remission off and on therapy: remission off therapy requires the patient to be on no other treatment for SLE than maintenance antimalarials; and remission on therapy allows patients to be on stable maintenance antimalarials, low-dose corticosteroids (prednisone ≤5 mg/day), maintenance immunosuppressives and/or maintenance biologics.The task force also agreed that the most appropriate outcomes (dependent variables) for testing the prognostic value (construct validity) of potential remission definitions are: death, damage, flares and measures of health-related quality of life.CONCLUSIONS: The work of this international task force provides a framework for testing different definitions of remission against long-term outcomes.",

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year = "2017",

month = mar,

doi = "10.1136/annrheumdis-2016-209519",

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volume = "76",

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journal = "Annals of the Rheumatic Diseases",

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TY - JOUR

T1 - A framework for remission in SLE

T2 - consensus findings from a large international task force on definitions of remission in SLE (DORIS)

AU - van Vollenhoven, Ronald

AU - Voskuyl, Alexandre

AU - Bertsias, George

AU - Aranow, Cynthia

AU - Aringer, Martin

AU - Arnaud, Laurent

AU - Askanase, Anca

AU - Balážová, Petra

AU - Bonfa, Eloisa

AU - Bootsma, Hendrika

AU - Boumpas, Dimitrios

AU - Bruce, Ian

AU - Cervera, Ricard

AU - Clarke, Ann

AU - Coney, Cindy

AU - Costedoat-Chalumeau, Nathalie

AU - Czirják, László

AU - Derksen, Ronald

AU - Doria, Andrea

AU - Dörner, Thomas

AU - Fischer-Betz, Rebecca

AU - Fritsch-Stork, Ruth

AU - Gordon, Caroline

AU - Graninger, Winfried

AU - Györi, Noémi

AU - Houssiau, Frédéric

AU - Isenberg, David

AU - Jacobsen, Soren

AU - Jayne, David

AU - Kuhn, Annegret

AU - Le Guern, Veronique

AU - Lerstrøm, Kirsten

AU - Levy, Roger

AU - Machado-Ribeiro, Francinne

AU - Mariette, Xavier

AU - Missaykeh, Jamil

AU - Morand, Eric

AU - Mosca, Marta

AU - Inanc, Murat

AU - Navarra, Sandra

AU - Neumann, Irmgard

AU - Olesinska, Marzena

AU - Petri, Michelle

AU - Rahman, Anisur

AU - Rekvig, Ole Petter

AU - Rovensky, Jozef

AU - Shoenfeld, Yehuda

AU - Smolen, Josef

AU - Tincani, Angela

AU - Urowitz, Murray

AU - van Leeuw, Bernadette

AU - Vasconcelos, Carlos

AU - Voss, Anne

AU - Werth, Victoria P

AU - Zakharova, Helena

AU - Zoma, Asad

AU - Schneider, Matthias

AU - Ward, Michael

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

PY - 2017/3

Y1 - 2017/3

N2 - OBJECTIVES: Treat-to-target recommendations have identified 'remission' as a target in systemic lupus erythematosus (SLE), but recognise that there is no universally accepted definition for this. Therefore, we initiated a process to achieve consensus on potential definitions for remission in SLE.METHODS: An international task force of 60 specialists and patient representatives participated in preparatory exercises, a face-to-face meeting and follow-up electronic voting. The level for agreement was set at 90%.RESULTS: The task force agreed on eight key statements regarding remission in SLE and three principles to guide the further development of remission definitions:1. Definitions of remission will be worded as follows: remission in SLE is a durable state characterised by …………………. (reference to symptoms, signs, routine labs).2. For defining remission, a validated index must be used, for example, clinical systemic lupus erythematosus disease activity index (SLEDAI)=0, British Isles lupus assessment group (BILAG) 2004 D/E only, clinical European consensus lupus outcome measure (ECLAM)=0; with routine laboratory assessments included, and supplemented with physician's global assessment.3. Distinction is made between remission off and on therapy: remission off therapy requires the patient to be on no other treatment for SLE than maintenance antimalarials; and remission on therapy allows patients to be on stable maintenance antimalarials, low-dose corticosteroids (prednisone ≤5 mg/day), maintenance immunosuppressives and/or maintenance biologics.The task force also agreed that the most appropriate outcomes (dependent variables) for testing the prognostic value (construct validity) of potential remission definitions are: death, damage, flares and measures of health-related quality of life.CONCLUSIONS: The work of this international task force provides a framework for testing different definitions of remission against long-term outcomes.

AB - OBJECTIVES: Treat-to-target recommendations have identified 'remission' as a target in systemic lupus erythematosus (SLE), but recognise that there is no universally accepted definition for this. Therefore, we initiated a process to achieve consensus on potential definitions for remission in SLE.METHODS: An international task force of 60 specialists and patient representatives participated in preparatory exercises, a face-to-face meeting and follow-up electronic voting. The level for agreement was set at 90%.RESULTS: The task force agreed on eight key statements regarding remission in SLE and three principles to guide the further development of remission definitions:1. Definitions of remission will be worded as follows: remission in SLE is a durable state characterised by …………………. (reference to symptoms, signs, routine labs).2. For defining remission, a validated index must be used, for example, clinical systemic lupus erythematosus disease activity index (SLEDAI)=0, British Isles lupus assessment group (BILAG) 2004 D/E only, clinical European consensus lupus outcome measure (ECLAM)=0; with routine laboratory assessments included, and supplemented with physician's global assessment.3. Distinction is made between remission off and on therapy: remission off therapy requires the patient to be on no other treatment for SLE than maintenance antimalarials; and remission on therapy allows patients to be on stable maintenance antimalarials, low-dose corticosteroids (prednisone ≤5 mg/day), maintenance immunosuppressives and/or maintenance biologics.The task force also agreed that the most appropriate outcomes (dependent variables) for testing the prognostic value (construct validity) of potential remission definitions are: death, damage, flares and measures of health-related quality of life.CONCLUSIONS: The work of this international task force provides a framework for testing different definitions of remission against long-term outcomes.

KW - Adrenal Cortex Hormones

KW - Antibodies, Antinuclear

KW - Antimalarials

KW - Complement System Proteins

KW - Consensus

KW - DNA

KW - Humans

KW - Immunosuppressive Agents

KW - Lupus Erythematosus, Systemic

KW - Maintenance Chemotherapy

KW - Remission Induction

KW - Severity of Illness Index

KW - Symptom Flare Up

KW - Consensus Development Conference

KW - Journal Article

KW - Review

UR - https://www.scopus.com/pages/publications/85006051899

U2 - 10.1136/annrheumdis-2016-209519

DO - 10.1136/annrheumdis-2016-209519

M3 - Review

C2 - 27884822

SN - 0003-4967

VL - 76

SP - 554

EP - 561

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

IS - 3

ER -

A framework for remission in SLE: consensus findings from a large international task force on definitions of remission in SLE (DORIS)

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