Setting the international standard for lupus remission

Before the publication of the 2021 DORIS definition of remission in SLE: final recommendations from an international task force in Lupus Science & Medicine¹, researchers studying remission in systemic lupus erythematosus (SLE) used more than 20 different definitions of remission, making it difficult to compare studies and establish common treatment goals for their patients.

As interest grew in treat-to-target approaches, in which clinicians aim for a specific treatment goal such as remission, the lack of a standard definition became increasingly problematic. Clinicians needed a clear and evidence based target to guide treatment decisions, while researchers required a consistent outcome measure that could be used across studies and clinical trials.

To address this challenge, an international task force of clinicians, researchers, and patients spent several years developing a consensus definition of remission in SLE. The result was the 2021 DORIS (Definitions Of Remission In SLE) recommendations, published in Lupus Science & Medicine—a specialist open access journal for lupus research owned by the Lupus Foundation of America and published by BMJ Group.

Since publication, the paper has been cited more than 350 times, with more than 70% of citations occurring in the past two years, demonstrating continuing and growing relevance across the field.

Lead author Ronald van Vollenhoven, professor of rheumatology at Amsterdam UMC, says the definition has been adopted by virtually all researchers studying remission in lupus. Studies examining remission rates, treatment outcomes, and disease control now routinely use the DORIS definition, creating a common language that enables meaningful comparison between studies and research groups worldwide.

The recommendations have also influenced clinical practice and policy. The DORIS definition has been incorporated into international treatment recommendations and supports treat-to-target approaches, helping clinicians move from a reactive model of care towards a more proactive strategy focused on achieving defined patient outcomes.

Its influence extends into drug development. Pharmaceutical companies increasingly include DORIS remission as a key secondary endpoint in lupus clinical trials, reflecting growing acceptance of remission as an important measure of treatment success². Professor van Vollenhoven indicates that DORIS remission is now used routinely as a secondary outcome in company-sponsored lupus trials. 

“More and more clinical trials, company-sponsored clinical trials, have used DORIS as a secondary outcome, or sometimes an exploratory outcome.”  Ronald F. van Vollenhoven, MD, PhD, MACR 

The definition has also been cited in lupus treatment clinical guidelines, such as the 2024 Mexican Guidelines for the Treatment of Systemic Lupus Erythematosus³. The latter was developed by the Colegio Mexicano de Reumatología (Mexican College of Rheumatology) using the GRADE methodology and updated the 2017 guidance, adding recommendations on vaccination, pregnancy and cardiovascular risk. 

For patients, the DORIS definition helps shift the focus of care beyond simply reducing disease activity. Instead, it provides a recognised and measurable goal of remission. As Professor van Vollenhoven explains, improving symptoms is important, but achieving a state in which the disease is under control is a more meaningful outcome. By defining what remission looks like, DORIS provides clinicians, researchers, regulators, and industry with a shared framework for assessing success.

By replacing more than 20 competing definitions of remission with a single internationally agreed standard, the DORIS recommendations have helped harmonise lupus research and improve the comparability of evidence generated across different studies and settings. Professor van Vollenhoven says that this is one of the driving reasons for producing the DORIS initiative.

Impact at a glance *