Defining remission in childhood-onset lupus: PReS-endorsed consensus definitions by an international task force
Eve Smith, Amita Aggarwal, Jenny Ainsworth, Eslam Al‐Abadi, Tadej Avčin, Lynette Bortey, Jon M. Burnham, Coziana Ciurtin, Christian M. Hedrich, Sylvia Kamphuis, L. Lambert, Deborah M. Levy, Laura B. Lewandowski, Naomi Maxwell, Eric F. Morand, Seza Özen, Clare Pain, Angelo Ravelli, Cláudia Saad Magalhães, C Pilkington, Dieneke Schonenberg‐Meinema, Christiaan Scott, Kjell Tullus, Michael W. Beresford, Béatrice Goilav, Natasha Goss, Louise Oni, Stephen D. Marks
Abstract
OBJECTIVE: To derive childhood-onset SLE (cSLE) specific remission definitions for future treat-to-target (T2T) trials, observational studies, and clinical practice. METHODS: The cSLE International T2T Task Force conducted Delphi surveys exploring paediatric perspectives on adult-onset SLE remission targets. A modified nominal group technique was used to discuss, refine, and agree on the cSLE remission target criteria. RESULTS: The Task Force proposed two definitions of remission: 'cSLE clinical remission on steroids (cCR)' and 'cSLE clinical remission off steroids (cCR-0)'. The common criteria are: (1) Clinical-SLEDAI-2 K = 0; (2) PGA score < 0.5 (0-3 scale); (4) stable antimalarials, immunosuppressive, and biologic therapy (changes due to side-effects, adherence, weight, or when building up to target dose allowed). Criterion (3) in cCR is the prednisolone dose ≤0.1 mg/kg/day (maximum 5 mg/day), whereas in cCR-0 it is zero. CONCLUSIONS: cSLE definitions of remission have been proposed, maintaining sufficient alignment with the adult-SLE definition to facilitate life-course research.