Clinicians approaches to management of background treatment in patients with SLE in clinical remission: results of an international observational survey
Open Access
- 29 June 2017
- journal article
- research article
- Published by BMJ in Lupus Science & Medicine®
- Vol. 4 (1), e000173
- https://doi.org/10.1136/lupus-2016-000173
Abstract
Background The definition of remission in systemic lupus erythematosus (SLE) remains unclear, especially how background treatment should be interpreted. Objective To determine preferences of clinicians in treatment of patients in clinical remission from SLE and to assess how previous severity, duration of remission and serology influence changes in treatment. Methods We undertook an internet-based survey of clinicians managing patients with SLE. Case scenarios were constructed to reflect different remission states, previous organ involvement, serological abnormalities, duration of remission and current treatment (hydroxychloroquine (HCQ), steroids and/or immunosuppressive (ISS) agents). Results 130 clinicians from 30 countries were surveyed. The median (range) duration of practice and number of patients with SLE seen each month was 13 (2–42) years and 30 (2–200), respectively. Management decisions in all scenarios varied with greater caution in treatment reduction with shorter duration of remission, extent of serological abnormalities and previous disease severity. Even with mild disease, normal serology and a 5-year clinical remission, 113 (86.9%) clinicians continue to prescribe HCQ. Persistent abnormal serology in any scenario led to a reluctance to reduce or discontinue medications. Prescribing in remission, particularly of steroids and HCQ, varied significantly according to geographical location. Conclusions Clinicians preferences in withdrawing or reducing treatment in patients with SLE in clinical remission vary considerably. Serological abnormalities, previous disease severity and duration of remission all influence the decision to reduce treatment. It is unusual for clinicians to stop HCQ even after prolonged periods of clinical remission. Any definition(s) of remission needs to take into consideration such evidence on how maintenance treatments are managed.Keywords
This publication has 23 references indexed in Scilit:
- Treat-to-target in systemic lupus erythematosus: recommendations from an international task forceAnnals Of The Rheumatic Diseases, 2014
- Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritisAnnals Of The Rheumatic Diseases, 2012
- American College of Rheumatology guidelines for screening, treatment, and management of lupus nephritisArthritis Care & Research, 2012
- International consensus for a definition of disease flare in lupusLupus, 2010
- EULAR recommendations for the management of systemic lupus erythematosus with neuropsychiatric manifestations: report of a task force of the EULAR standing committee for clinical affairsAnnals Of The Rheumatic Diseases, 2010
- Systemic Lupus ErythematosusNew England Journal of Medicine, 2008
- EULAR recommendations for the management of systemic lupus erythematosus. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including TherapeuticsAnnals Of The Rheumatic Diseases, 2007
- Prolonged remission in systemic lupus erythematosus.2005
- Morbidity and Mortality in Systemic Lupus Erythematosus During a 10-Year PeriodMedicine, 2003
- Patterns of disease activity in systemic lupus erythematosusArthritis & Rheumatism, 1999