SLE DAS is a potential outcome measure in SLE

SLEDAS is a potential weight based global outcome measure , easy to perform

1. SLE-DAS as an activity & outcome measure in SLE Dr Ritasman Baisya

2. Disease activity measures in SLE SLEDAI 2K – easy to do, validated, many domains are not included, not good for clinical trial BILAG – organ domain-based, exhaustive, difficult to do in clinical practice Easy BILAG – less exhaustive , however, it also takes a lot of time There is a need for a single disease score that can easily be scored , including more domains and can be used as a marker of flare

3. 520 patients with SLE from two tertiary care centres (derivation and validation cohorts ). ( 1) Correlations between SLE-DAS, PGA and SLEDAI-2K ( 2) Performance of SLEDAI-2K and SLE-DAS in identifying a clinically meaningful change in disease activity ( Δ PGa≥0.3 ) (3 ) Accuracy of SLEDAI-2K and SLE DAS time-adjusted means in predicting damage accrual.

4. SLE - DAS domains treat-to-target management of SLE patients providing a useful instrument for guiding treatment strategies outcomes research identifying candidates for clinical trials. Correlate well with SLEDAI , PGA ,LQOL Single score to predict flare , remission

5. Determination of item weight Linear scale Logarithmic scale NPSLE ( * 18 ) Proteinuria Systemic vasculitis ( * 18 ) Total leukocyte count Mucocutaneous vasculitis ( * 4.4) Platelet count Cardio-pulmonary ( * 18 ) Serositis * 6 Myositis * 6 AIHA * 9 Arthritis (* 3) , swollen joint (*0.45) Local rash ( *3 ) , generalized rash ( *4) Alopecia ( * 0.9 ) , Mucosal lesion ( * 2.8 ) Complement ( * 0.75 ) Ds DNA ( *0.9)

6. Internal & external validation SLE-DAS correlated well with PGA & SLEDAI 2K SLE-DAS variation had a higher discriminative performance (AUC=0.927 ) than SLEDAI-2K (AUC=0.787 ) SLEDAS also predicts damage accrual ( SLE DAS model better than SLEDAI for damage ) A variation in SLE-DAS ≥ 1.72 had a higher sensitivity to detect a clinically meaningful change in SLE disease activity compared with a SLEDAI-2K≥4 variation

7. The SLE-DAS had the highest sensitivity (97.1%), while SLEDAI-2k had the lowest sensitivity (56.5%) in identifying flare The overall measure of the classification performance was highest for the SLE-DAS (97.2%, 95% CI 93.3– 99.0)

8. 292 patients with LLDAS at base Flare – revised SLE flare index ( r-SFI) , SLEDAI flare , SLEDAS 28.4%, 24.7% and 13.4% of the patients developed one or more flare , according to r-SFI, SLE-DAS and SLEDAI-2K definitions, respectively. The predictors of SLE-DAS flares were the presence of anti-U1RNP , SLE-DAS score at baseline, and immunosuppressants .

9. SLE-DAS disease activity category

10. SLE-DAS was scored retrospectively cut-off for SDA was derived using receiver operating characteristic (ROC) curves against the BILAG-2004 numerical score >11 as gold standard The optimal SLE-DAS cut-off for SDA was >9.90 The SLE-DAS cut-off was associated with worse HR- QoL across multiple PROs more consistently than BILAG-2004 or SLEDAI-2K .

11. Research idea Multi-centric validation of SLEDAS as a potential disease outcome measure in the Indian SLE cohort. Comparative evaluation of SLEDAS flare with SFI index in Indian lupus. Predictors of flare in Indian Lupus using different flare indices, including SLEDAS. Serum HCQ concentration as flare prediction in Indian lupus using different flare indices, including SLEDAS. Does the omission of fever in SLEDAS alter its correlation with SLEDAI or BILAG in Indian lupus? Renal SLEDAS versus Renal SLEDAI in Indian SLE patients to achieve remission

12. Ease of the study Purely clinical data, no major investigations SLEDAS is a continuous variable, potential to detect subtle changes Calculating SLEDAS & SLEDAI both are easy in a busy OPD setting Validate a single score rather than multiple parameters for the definition of flare and remission