Table 2.

Effect of remission and LLDAS on damage accrual in observational cohorts

Author	Year of publication	Number of patients	Clinical remission on/off therapy	LLDAS ≥50%	Association with damage accrual
					Remission	LLDAS ≥50%
Zen et al. [32]	2015	224	37.4% of patients had ≥5 consecutive years of remission		Unremitted disease had higher odds of damage accrual (OR 2.53; 95% CI 1.28, 4.99)
Franklyn et al. [33]	2016	191		33.0% of visits in LLDAS		Patients with LLDAS ≥50% lower risk of damage accrual (RR 0.47; 95% CI 0.28, 0.79)
Tsang-A-Sjoe et al. [34]	2017	183	32.5% of patients had ≥5 consecutive years of remission	64.5% of patients had ≥50% of visits in LLDAS	Reduced risk of damage accrual for patients ≥5 consecutive years of remission (OR 0.20; 95% CI 0.07, 0.052)	Reduced risk of damage accrual (OR 0.52; 95% CI 0.28, 0.99)
Mok et al. [35]	2017	769	25.1% of patients had ≥5 consecutive years of remission		Reduced risk of damage accrual for patients ≥5 consecutive years of remission (OR 0.17; s.d. ±0.53, P<0.001)
Ugarte-Gil et al. [36]	2017	1350	11.6% of visits in remission	10% of visits in LDAS	Patients in remission had a lower hazard of new damage (HR 0.53; 95% CI 0.38, 0.75). No effect on mortality.	Patients in LDAS had a lower hazard of new damage (HR 0.61; 95% CI 0.44, 0.85). No effect on mortality.
Zen et al. [37]	2017	293		37.2% of patients in LLDAS ≥5 years		Reduced damage accrual for patients in ≥2 years of LLDAS
Petri et al. [38]	2018	1356	40% of follow-up time was spent in any form of remission	50% of follow-up time was spent in LLDAS	Longer time spent in remission was associated with lower hazard ratio of damage accrual. Rate of events/10 personyears >0–<25%: 1.01 25–49%: 0.86 50–74%: 0.77 >75%: 0.77	Longer time spent in LLDAS was associated with lower hazard ratio of damage accrual. Rate of events/10 personyears >0–<25%: 1.52 25–49%: 1.22 50–74%: 0.88 >75%: 0.75
Tani et al. [39]	2018	115	45% of visits in remission on therapy	70% of visits in LLDAS	Reduced damage accrual for patients in remission at all visits compared to patients who were not (0.12 vs 0.48 points, P=0.018)	Reduced damage accrual for patients in LLDAS at all visits compared to patients who were not (0.11 vs 0.63 points, P<0.001)
Fasano et al. [40]	2019	294	44.5% of patients had ≥5 consecutive years of remission		Patients in remission for 5 consecutive years had a greater overall cardiovascular event-free rate. HR 0.11 (95% CI 0.02, 0.47)
Alarcón et al. [41]a	2019	558	1.8% of visits in remission	15.1% of visits in LDAS	Time spent in combined remission/LDAS was associated with reduced damage accrual. Rate ratio 0.18 (95% CI 0.12, 0.26)
Golder et al. [42]	2019	1707		47.9% of visits in LLDAS		Attainment of LLDAS at any timepoint was associated with reduction in damage accrual (hazard ratio 0.59, 95% CI 0.45, 0.76). Patients in LLDAS ≥50% reduced risk of damage accrual (HR 0.54; 95% CI 0.42, 0.70) and flare (HR 0.41; 95% CI 0.35, 0.48)
Golder et al. [43]	2019	1707	35.8% of visits in remission (definition 3)		Patients in ≥50% visits in remission (definition 3) reduced risk of damage accrual (HR 0.49; 95% CI 0.38, 0.65)	LLDAS more attainable (47.9% of visits) with similar risk reduction (HR 0.54; 95% CI 0.42, 0.70)
Floris et al. [44]	2019	116	21.6% clinical remission 6 months after diagnosis	42.2% LLDAS 6 months after diagnosis	Reduced damage accrual for patients in clinical remission after 6 months (OR 0.10; 95% CI 0.01, 0.77)	Reduced damage accrual for patients in LLDAS after 6 months (OR 0.20; 95% CI 0.05, 0.50)
Sharma et al. [45]	2020	69		33.5% of patients LLDAS ≥50% of visits		Patients in LLDAS ≥50% reduced risk of damage accrual (HR 0.37; 95% CI 0.19, 0.73) and mortality (HR 0.31; 95% CI 0.16, 0.62)

^aDisease activity measured with SLAM. HR: hazard ratio; LDAS: low disease activity score according to individual study criteria; LLDAS: lupus low disease activity score; OR: odds ratio; RR: relatice risk as defined by Franklyn et al. [46]