Background: Systemic lupus erythematosus (SLE) is characterized by a wide spectrum clinical manifestation. It is well established that Asian patients tend to have more severe disease. Malaysia is a country with a diverse ethnic composition, which may influence the disease course progression. Treat-to-target strategies to achieve remission (DORIS Remission) and LLDAS (low lupus disease activity state) have improved patient outcomes. However, since SLE is a complex multi-systemic autoimmune disease, the implementation of this treatment strategy is challenging, especially in a diverse multi-ethnic population.

Objectives: To determine the rate of LLDAS attainment and/or DORIS remission in a diverse multi-ethnic Malaysian SLE patients and its association with organ damage.

Methods: This was a retrospective study conducted in 22 Rheumatology centres in Malaysia. Patients with SLE who had a complete follow up from the onset of SLE diagnosis until the first LLDAS and/or DORIS attainment were included. Early attainment of LLDAS and/or DORIS remission is defined as attainment within 12 months of SLE onset. Note, LLDAS and DORIS remission were used, but omitting the Physician’s Global Assessment. Univariable and multivariable logistic regression analysis was performed to determine factors associated with delayed remission and the association with organ damage.

Results: A total of 1707 patients were included, most of whom were females (92.6%, n=1575). The ethnic compositions were as follows: Malay (n=952, 65%) followed by Chinese (n=266, 18.2%), Sabahan indigeneous (n=116, 7.9%), indigeneous (n=52, 3.5%) and Indian (n=50, 3.4%). Majority had initial mucocutaneous manifestations (n=1244, 72.9%), followed by haematological (n=1138, 66.7%), musculoskeletal (n=1067, 62,5%), constitutional (n=848, 49.9%), renal (n=561, 32.9%), serositis (n=229, 13.4%), neuropsychiatric lupus/NPSLE (n=19, 9.9%), gastrointestinal (n=70, 4.1%). A total of 1578 subjects had a complete period of observation of at least 12 months from diagnosis. The prevalence of early attainment of LLDAS and/or DORIS was 44.6%, n=704/1578 patients (DORIS remission 38.5%, n=607 and LLDAS attainment 6.1%, n=97). There were significant ethnic disparities in remission attainment, as more Malay (53.5% vs 46.3%, p=0.012) patients had delayed remission while significantly lesser Sabah (33.3% vs 52.6%, p<0.001) and Sarawak indigenous (36.5% vs 51.5%, p=0.045) had delayed remission compared to the other ethnic group. Multivariable logistic regression analysis revealed that delayed remission was associated with SLE duration [OR 1.07(1.001-1.142), P=0.047], NPSLE [OR 3.12 (1.29-7.54), P=0.01] and anti-B2 glycoprotein 1 IgG [OR 2.29 (1.02-5.17), P=0.04] and organ damage [OR 2.414 (0.997-5.844), P=0.05]

Conclusion: Early attainment of LLDAS and/or DORIS was achieved in more than one third of our patients. However, there were significant ethnic disparities in remission attainment with a significantly higher Malay population, who is the major ethnic group in Malaysia had delayed remission. Delayed remission was associated with longer SLE duration, presence of NPSLE, anti-B2 Glycoprotein1 IgG and organ damage.

REFERENCES: [1] Yang Z, Cheng C, Wang Z, Wang Y, Zhao J, Wang Q, Tian X, Hsieh E, Li M, Zeng X. Prevalence, Predictors, and Prognostic Benefits of Remission Achievement in Patients With Systemic Lupus Erythematosus: A Systematic Review. Arthritis Care Res (Hoboken). 2022 Feb;74(2):208-218.

Acknowledgements: This study is an investigator-initiated research and received funding from AstraZeneca Sdn Bhd. This study obtained ethics approval from UKM Medical Research Ethics Committee (FF-2023-275) and Medical Research & Ethics Committee Ministry of Health Malaysia (NMRR ID-23-02672-VNL (IIR).

Disclosure of Interests: Syahrul Sazliyana Shaharir AstraZeneca, AstraZeneca, Cheng Lay Teh: None declared, Chun Ruh Ng: None declared, Asmahan Mohamed Ismail: None declared, Hairul Hadi Ariff: None declared, Anna Farazilah Mohd Salleh: None declared, Asmah Mohd: None declared, Chua Houy: None declared, Azwarina Hanim Ramlan: None declared, Sharifah Aishah Wan Mohamad Akbar: None declared, Jasmin Raja Boehringer, Novartis, Boehringer, Novartis, Boehringer, Novartis, Fariz Yahya Novartis, Pfizer, Abbvie, Novartis, Pfizer, Abbvie, Novartis, Pfizer, Abbvie, Shakira Selvananda: None declared, Wan Syamimee Wan Ghazali: None declared, Suhaida Ahmad Maulana: None declared, Eashwary Mageswaren: None declared, Hazlyna Baharuddin: None declared, Nur Farhana Abd Manaf: None declared, Sow Lai Kan: None declared, Noraini Mat Husin: None declared, Guo Ruey Ling: None declared, Cheon Han Goh: None declared, Wan Rosmaiza Wan Musa: None declared, Liza Mohd Isa: None declared, Nor Shuhaila Shahril: None declared, Norliza Zainudin: None declared, Mollyza Mohd Zain: None declared, Habibah Mohd Yusoof: None declared, Shereen Ch’ng Suyin AstraZeneca, Novartis, Abbvie, Hashimah Abu Mansor Matardiah: None declared, Malehah Mohd Noh AstraZeneca, Syang Pyng Gan: None declared, Shiau Li Lim: None declared, Mohd Shahrir Mohamed Said: None declared, Sakthiswary Rajalingham: None declared, Rozita Mohd: None declared, Hwee Cheng Chong: None declared, Hooi Chuen Hong: None declared, Jasmine Yew: None declared, Siti Mariam Abd Rahim: None declared, Nadiah Mohd Noor: None declared, Farah Nadiah Sulaiman: None declared, Mariam Hamid Mustapha: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.