LBS1:04 DORIS-PLUS: towards a definition of deep remission in lupus

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Objectives The 2021 definition of remission in SLE (DORIS) has been widely used in clinical research. Since then, case series have suggested that a deeper state of remission is attainable for at least some patients. The DORIS Task Force committed itself to developing a suitable definition for a state of deep remission, entitled DORIS-PLUS (DORIS+).The objective of the Task Force was to obtain a consensus-based, data-driven definition of deep remission in systemic lupus erythematosus (SLE), for use in parallel with, not as a replacement for, the existing DORIS definition .Methods Following initial literature surveys and preliminary work, the international DORIS+ Task Force, comprising patients and specialists in rheumatology, nephrology, dermatology and clinical immunology, held two plenary meetings, collected feedback through an international survey, and held live voting rounds applying an 80% consensus threshold.Results The Task Force agreed on the following verbatim definition: ‘DORIS+ represents the state beyond clinical remission that is a meaningful outcome for patients with SLE and that may now be within reach for some.’ Consensus was also achieved that this definition will include specifications for clinical quiescence, immunological reset, limitations on treatment and a favorable patient experience. The Task Force remained divided on the inclusion of duration into the definition. The agreed-upon consensus statements, as well as statements on which consensus was not yet achieved, are shown in table 1. The Task Force also achieved consensus on definitions of remission in lupus arthritis, hematological lupus, cardiopulmonary lupus, and CNS lupus. For other organ systems no consensus was achieved, and the need for post-treatment renal biopsies emerged as the most controversial topic.Abstract LBS1:04 Table 1Statements and percentage agreement from the DORIS+ task forceConclusions The DORIS+ Task Force defined several important elements of the DORIS+ definition. A research agenda was defined that will help resolve several remaining issues. The final DORIS+ definition is anticipated in the academic year 2026-2027.

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