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

Objectives: Treat-to-target recommendations have identified ‘remission’ as a target in systemic lupus erythematosus (SLE) but recognize 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 sixty 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%.ResultsThe 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 characterized by …………………. (reference to symptoms, signs, routine labs).2. For defining remission a validated index must be used, e.g., clinical-SLEDAI = 0, BILAG2004 D/E only, clinical ECLAM =0; with routine laboratory assessments included, and supplemented with Physician 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 Remissionon-therapy allows patients to be on stable maintenance antimalarials, low-dose corticosteroids (prednisone <5 mg/d), 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.ConclusionThe work of this international task force provides a framework for testing different definitions of remission against longer-term outcomes.