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 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.
['van Vollenhoven|Ronald|R|', 'Voskuyl|Alexandre|A|', 'Bertsias|George|G|', 'Aranow|Cynthia|C|', 'Aringer|Martin|M|', 'Arnaud|Laurent|L|', 'Askanase|Anca|A|', 'Balážová|Petra|P|', 'Bonfa|Eloisa|E|', 'Bootsma|Hendrika|H|', 'Boumpas|Dimitrios|D|', 'Bruce|Ian|I|', 'Cervera|Ricard|R|', 'Clarke|Ann|A|', 'Coney|Cindy|C|', 'Costedoat-Chalumeau|Nathalie|N|', 'Czirják|László|L|', 'Derksen|Ronald|R|', 'Doria|Andrea|A|', 'Dörner|Thomas|T|', 'Fischer-Betz|Rebecca|R|', 'Fritsch-Stork|Ruth|R|', 'Gordon|Caroline|C|', 'Graninger|Winfried|W|', 'Györi|Noémi|N|', 'Houssiau|Frédéric|F|', 'Isenberg|David|D|', 'Jacobsen|Soren|S|', 'Jayne|David|D|', 'Kuhn|Annegret|A|', 'Le Guern|Veronique|V|', 'Lerstrøm|Kirsten|K|', 'Levy|Roger|R|', 'Machado-Ribeiro|Francinne|F|', 'Mariette|Xavier|X|', 'Missaykeh|Jamil|J|', 'Morand|Eric|E|', 'Mosca|Marta|M|', 'Inanc|Murat|M|', 'Navarra|Sandra|S|', 'Neumann|Irmgard|I|', 'Olesinska|Marzena|M|', 'Petri|Michelle|M|', 'Rahman|Anisur|A|', 'Rekvig|Ole Petter|OP|', 'Rovensky|Jozef|J|', 'Shoenfeld|Yehuda|Y|', 'Smolen|Josef|J|http://orcid.org/0000-0002-8899-9087', 'Tincani|Angela|A|', 'Urowitz|Murray|M|', 'van Leeuw|Bernadette|B|', 'Vasconcelos|Carlos|C|', 'Voss|Anne|A|', 'Werth|Victoria P|VP|', 'Zakharova|Helena|H|', 'Zoma|Asad|A|', 'Schneider|Matthias|M|', 'Ward|Michael|M|']
D000305:Adrenal Cortex Hormones D000974:Antibodies, Antinuclear D000962:Antimalarials D003165:Complement System Proteins D032921:Consensus D004247:DNA D006801:Humans D007166:Immunosuppressive Agents D008180:Lupus Erythematosus, Systemic D060046:Maintenance Chemotherapy D012074:Remission Induction D012720:Severity of Illness Index D000067251:Symptom Flare Up
Systemic Lupus Erythematosus Disease Activity Outcomes research