REFERENCES
1. Zen M, Salmaso L, Amidei CB, et al. Mortality and causes of death in systemic lupus erythematosus over the last decade: data from a large population-based study. Eur J Intern Med. 2023;112:45-51.
2. Eastman RC, Keen H. The impact of cardiovascular disease on people with diabetes: the potential for prevention. Lancet. 1997;350 Suppl 1:SI29-32.
3. Gatto M, Zen M, Iaccarino L, Doria A. New therapeutic strategies in systemic lupus erythematosus management. Nat Rev Rheumatol. 2019;15:30-48.
4. Doria A, Gatto M, Zen M, Iaccarino L, Punzi L. Optimizing outcome in SLE: treating-to-target and definition of treatment goals. Autoimmun Rev. 2014;13:770-7.
5. van Vollenhoven RF, Bertsias G, Doria A, et al. 2021 DORIS definition of remission in SLE: final recommendations from an international task force. Lupus Sci Med. 2021;8:e000538.
6. Franklyn K, Lau CS, Navarra SV, et al; Asia-Pacific Lupus Collaboration. Definition and initial validation of a lupus low disease activity state (LLDAS). Ann Rheum Dis. 2016;75:1615-21.
7. Zen M, Iaccarino L, Gatto M, et al. Prolonged remission in caucasian patients with SLE: prevalence and outcomes. Ann Rheum Dis. 2015;74:2117-22.
8. Ugarte-Gil MF, Wojdyla D, Pons-Estel GJ, et al; GLADEL. Remission and low disease activity status (LDAS) protect lupus patients from damage occurrence: data from a multiethnic, multinational Latin American Lupus Cohort (GLADEL). Ann Rheum Dis. 2017;76:2071-4.
9. Polachek A, Gladman DD, Su J, Urowitz MB. Defining low disease activity in systemic lupus erythematosus. Arthritis Care Res. 2017;69:997-1003.
10. Tselios K, Gladman DD, Touma Z, Su J, Anderson N, Urowitz MB. Clinical remission and low disease activity outcomes over 10 years in systemic lupus erythematosus. Arthritis Care Res. 2019;71:822-8.
11. Alarcón GS, Ugarte-Gil MF, Pons-Estel G, Vilá LM, Reveille JD, McGwin G Jr. Remission and low disease activity state (LDAS) are protective of intermediate and long-term outcomes in SLE patients. Results from LUMINA (LXXVIII), a multiethnic, multicenter US cohort. Lupus. 2019;28:423-6.
12. Jesus D, Larosa M, Henriques C, et al. Systemic lupus erythematosus disease activity score (SLE-DAS) enables accurate and user-friendly definitions of clinical remission and categories of disease activity. Ann Rheum Dis. 2021;80:1568-74.
13. Ugarte-Gil MF, Hanly J, Urowitz M, et al. Remission and low disease activity (LDA) prevent damage accrual in patients with systemic lupus erythematosus: results from the systemic lupus international collaborating clinics (SLICC) inception cohort. Ann Rheum Dis. 2022;81:1541-8.
14. van Vollenhoven RF, Mosca M, Bertsias G, et al. Treat-to-target in systemic lupus erythematosus: recommendations from an international task force. Ann Rheum Dis. 2014;73:958-67.
15. Gatto M, Saccon F, Zen M, et al. Early Disease and low baseline damage as predictors of response to belimumab in patients with systemic lupus erythematosus in a real-life setting. Arthritis Rheumatol. 2020;72:1314-24.
16. Apostolopoulos D, Kandane-Rathnayake R, Louthrenoo W, et al; Asia-Pacific Lupus Collaboration. Factors associated with damage accrual in patients with systemic lupus erythematosus with no clinical or serological disease activity: a multicentre cohort study. Lancet Rheumatol. 2020;2:e24-30.
17. Zen M, Gatto M, Doria A. Defining the targets in SLE management: insights and unmet gaps. Ann Rheum Dis. 2022;81:1483-5.
18. Cruciani C, Zen M, Gatto M, Morand E, Doria A. Assessment of disease activity and damage in SLE: are we there yet? Best Pract Res Clin Rheumatol. 2023;37:101896.
19. Jesus D, Matos A, Henriques C, et al. Derivation and validation of the SLE disease activity score (SLE-DAS): a new SLE continuous measure with high sensitivity for changes in disease activity. Ann Rheum Dis. 2019;78:365-71.
20. Jesus D, Rodrigues M, Matos A, Henriques C, Pereira da Silva JA, Inês LS. Performance of SLEDAI-2K to detect a clinically meaningful change in SLE disease activity: a 36-month prospective cohort study of 334 patients. Lupus. 2019;28:607-12.
21. Samões B, Zen M, Abelha-Aleixo J, Gatto M, Doria A. Caveats and pitfalls in defining low disease activity in systemic lupus erythematosus. Autoimmun Rev. 2022;21:103165.
22. Chessa E, Piga M, Floris A, Devilliers H, Cauli A, Arnaud L. Use of physician global assessment in systemic lupus erythematosus: a systematic review of its psychometric properties. Rheumatology. 2020;59:3622-32.
23. Piga M, Chessa E, Morand EF, et al; PISCOS Investigator Group. Physician global assessment international standardisation consensus in systemic lupus erythematosus: the PISCOS study. Lancet Rheumatol. 2022;4:e441-9.
24. Ugarte-Gil MF, Mendoza-Pinto C, Reátegui-Sokolova C, et al. Achieving remission or low disease activity is associated with better outcomes in patients with systemic lupus erythematosus: a systematic literature review. Lupus Sci Med. 2021;8:e000542.
25. Gomez A, Lindblom J, Parodis I, Bertsias G. Treat-to-target in SLE: is serology important? Results from an integrated analysis of five randomized clinical trials of belimumab. Rheumatology. 2025;64:3598-605.
26. Kostopoulou M, Ugarte-Gil MF, Pons-Estel B, van Vollenhoven RF, Bertsias G. The association between lupus serology and disease outcomes: a systematic literature review to inform the treat-to-target approach in systemic lupus erythematosus. Lupus. 2022;31:307-18.
27. Morand EF, Abreu G, Furie RA, Golder V, Tummala R. Lupus low disease activity state attainment in the phase 3 TULIP trials of anifrolumab in active systemic lupus erythematosus. Ann Rheum Dis. 2023;82:639-45.
28. Morand EF, van Vollenhoven R, Furie RA, et al. LLDAS and remission attainment with anifrolumab treatment in patients with systemic lupus erythematosus: results from the TULIP and long-term extension randomised controlled trials. Ann Rheum Dis. 2025;84:777-88.
29. Petri M, Magder LS. Comparison of remission and lupus low disease activity state in damage prevention in a United States systemic lupus erythematosus cohort. Arthritis Rheumatol. 2018;70:1790-5.
30. Golder V, Kandane-Rathnayake R, Huq M, et al; Asia Pacific Lupus Collaboration. Evaluation of remission definitions for systemic lupus erythematosus: a prospective cohort study. Lancet Rheumatol. 2019;1:e103-10.
31. Tsang-A-Sjoe MW, Bultink IE, Heslinga M, Voskuyl AE. Both prolonged remission and lupus low disease activity state are associated with reduced damage accrual in systemic lupus erythematosus. Rheumatology. 2017;56:121-8.
32. Gatto M, Frontini G, Calatroni M, et al. Effect of sustained clinical remission on the risk of lupus flares and impaired kidney function in patients with lupus nephritis. Kidney Int Rep. 2024;9:1047-56.
33. Zen M, Iaccarino L, Gatto M, et al. The effect of different durations of remission on damage accrual: results from a prospective monocentric cohort of Caucasian patients. Ann Rheum Dis. 2017;76:562-5.
34. Saccon F, Zen M, Gatto M, et al. Remission in systemic lupus erythematosus: testing different definitions in a large multicentre cohort. Ann Rheum Dis. 2020;79:943-50.
35. Golder V, Kandane-Rathnayake R, Li N, et al; Asia Pacific Lupus Collaboration. Association of sustained lupus low disease activity state with improved outcomes in systemic lupus erythematosus: a multinational prospective cohort study. Lancet Rheumatol. 2024;6:e528-36.
36. Ugarte-Gil MF, Pons-Estel GJ, Vila LM, McGwin G, Alarcón GS. Time in remission and low disease activity state (LDAS) are associated with a better quality of life in patients with systemic lupus erythematosus: results from LUMINA (LXXIX), a multiethnic, multicentre US cohort. RMD Open. 2019;5:e000955.
37. Tsang-A-Sjoe MWP, Bultink IEM, Heslinga M, van Tuyl LH, van Vollenhoven RF, Voskuyl AE. The relationship between remission and health-related quality of life in a cohort of SLE patients. Rheumatology. 2019;58:628-35.
38. Emamikia S, Oon S, Gomez A, et al. Impact of remission and low disease activity on health-related quality of life in patients with systemic lupus erythematosus. Rheumatology. 2022;61:4752-62.
39. Pitsigavdaki S, Nikoloudaki M, Garantziotis P, et al. Pragmatic targets for moderate/severe SLE and their implications for clinical care and trial design: sustained DORIS or LLDAS for at least 6 months is sufficient while their attainment for at least 24 months ensures high specificity for damage-free progression. Ann Rheum Dis. 2024;83:464-74.
40. Oiwa H, Suga T, Hosokawa Y, Araki K. Glucocorticoid-free remission in patients with SLE in the era of biologics: Immune complex disease is likely to benefit from current medications. Lupus. 2024;33:502-10.
41. Tani C, Elefante E, Signorini V, et al. Glucocorticoid withdrawal in systemic lupus erythematosus: are remission and low disease activity reliable starting points for stopping treatment? A real-life experience. RMD Open. 2019;5:e000916.
42. Ginzler EM, Wallace DJ, Merrill JT, et al; LBSL02/99 Study Group. Disease control and safety of belimumab plus standard therapy over 7 years in patients with systemic lupus erythematosus. J Rheumatol. 2014;41:300-9.
43. Kandane-Rathnayake R, Golder V, Louthrenoo W, et al; Asia-Pacific Lupus Collaboration. Lupus low disease activity state and remission and risk of mortality in patients with systemic lupus erythematosus: a prospective, multinational, longitudinal cohort study. Lancet Rheumatol. 2022;4:e822-30.
44. Fasano S, Coscia MA, Pierro L, Ciccia F. Which patients with systemic lupus erythematosus in remission can withdraw low dose steroids? Results from a single inception cohort study. Lupus. 2021;30:991-7.
45. Tani C, Vagelli R, Stagnaro C, Carli L, Mosca M. Remission and low disease activity in systemic lupus erythematosus: an achievable goal even with fewer steroids? Real-life data from a monocentric cohort. Lupus Sci Med. 2018;5:e000234.
46. Assunção H, Jesus D, Larosa M, et al. Definition of low disease activity state based on the SLE-DAS: derivation and validation in a multicentre real-life cohort. Rheumatology. 2022;61:3309-16.
47. Golder V, Tsang-A-Sjoe MWP. Treatment targets in SLE: remission and low disease activity state. Rheumatology. 2020;59:v19-28.
48. Hunnicutt J, Georgiou ME, Richards A, et al. Patients achieving low lupus disease activity state, systemic lupus erythematosus disease control or remission showed lower rates of organ damage during longitudinal follow-up: analysis of the Hopkins Lupus Cohort. Lupus Sci Med. 2024;11:e001206.
49. Sharma C, Raymond W, Eilertsen G, Nossent J. Association of achieving lupus low disease activity state fifty percent of the time with both reduced damage accrual and mortality in patients with systemic lupus erythematosus. Arthritis Care Res. 2020;72:447-51.
50. Piga M, Floris A, Cappellazzo G, et al. Failure to achieve lupus low disease activity state (LLDAS) six months after diagnosis is associated with early damage accrual in Caucasian patients with systemic lupus erythematosus. Arthritis Res Ther. 2017;19:247.
51. Golder V, Kandane-Rathnayake R, Louthrenoo W, et al; Asia Pacific Lupus Collaboration. Comparison of attainment and protective effects of lupus low disease activity state in patients with newly diagnosed versus established systemic lupus erythematosus. J Rheumatol. 2024;51:790-7.
52. Kikuchi J, Hanaoka H, Saito S, et al. Lupus low disease activity state within 12 months is associated with favourable outcomes in severely active systemic lupus erythematosus. Rheumatology. 2022;61:3777-91.
53. Wilhelm TR, Magder LS, Petri M. Remission in systemic lupus erythematosus: durable remission is rare. Ann Rheum Dis. 2017;76:547-53.
54. Babaoğlu H, Li J, Goldman D, Magder LS, Petri M. Time to lupus low disease activity state in the Hopkins Lupus Cohort: role of African American ethnicity. Arthritis Care Res. 2020;72:225-32.
55. Zen M, Iaccarino L, Gatto M, et al. Lupus low disease activity state is associated with a decrease in damage progression in Caucasian patients with SLE, but overlaps with remission. Ann Rheum Dis. 2018;77:104-10.
56. Pawlak-Buś K, Schmidt W, Leszczyński P. Remission and low disease activity in Polish patients with systemic lupus erythematosus - real-life, five-year follow-up outcomes. Eur Rev Med Pharmacol Sci. 2023;27:949-59.
57. Ugarte-Gil MF, Wojdyla D, Pons-Estel GJ, et al. Predictors of remission and low disease activity state in systemic lupus erythematosus: data from a Multiethnic, Multinational Latin American Cohort. J Rheumatol. 2019;46:1299-308.
58. Hao Y, Hansen D, Louthrenoo W, et al. Characterisation and outcomes of different subsets of low disease activity states in patients with systemic lupus erythematosus. Lupus Sci Med. 2024;11:e001217.
59. Parodis I, Lindblom J, Levy RA, et al. Attainment of remission and low disease activity after treatment with belimumab in patients with systemic lupus erythematosus: a post-hoc analysis of pooled data from five randomised clinical trials. Lancet Rheumatol. 2024;6:e751-61.
60. Jesus D, Henriques C, Matos A, Doria A, Inês LS. Systemic lupus erythematosus disease activity score remission and low disease activity states discriminate drug from placebo and better health-related quality of life. Arthritis Care Res. 2024;76:788-95.
61. Patel A, MacMahon S, Chalmers J, et al; ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560-72.
62. Grigor C, Capell H, Stirling A, et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet. 2004;364:263-9.
63. Dures E, Shepperd S, Mukherjee S, et al. Treat-to-target in PsA: methods and necessity. RMD Open. 2020;6:e001083.
64. Kiltz U, Smolen J, Bardin T, et al. Treat-to-target (T2T) recommendations for gout. Ann Rheum Dis. 2017;76:632-8.
65. Doria A, Gatto M, Iaccarino L, Punzi L. Value and goals of treat-to-target in systemic lupus erythematosus: knowledge and foresight. Lupus. 2015;24:507-15.
66. Gatto M, Zen M, Cruciani C, Iaccarino L, Doria A. Navigating the landscape of SLE treatment: An expert viewpoint on the rationality and limitations of early biologic intervention. Autoimmun Rev. 2024;23:103612.
67. Zen M, Saccon F, Gatto M, et al. Prevalence and predictors of flare after immunosuppressant discontinuation in patients with systemic lupus erythematosus in remission. Rheumatology. 2020;59:1591-8.
68. Mathian A, Pha M, Haroche J, et al. Withdrawal of low-dose prednisone in SLE patients with a clinically quiescent disease for more than 1 year: a randomised clinical trial. Ann Rheum Dis. 2020;79:339-46.
69. Zen M, Fuzzi E, Loredo Martinez M, et al. Immunosuppressive therapy withdrawal after remission achievement in patients with lupus nephritis. Rheumatology. 2022;61:688-95.
70. Arora S, Yazdany J. Use of quality measures to identify disparities in health care for systemic lupus erythematosus. Rheum Dis Clin North Am. 2020;46:623-38.