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Arthritis Care Res (Hoboken). 2015 Sep;67(9):1237-45. doi: 10.1002/acr.22589.

Treatment Algorithms in Systemic Lupus Erythematosus.

Author information

1
Siriraj Hospital, Mahidol University, Bangkok, Thailand, and University of Western Ontario, London, Ontario, Canada.
2
Karolinska Institute, Stockholm, Sweden.
3
Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
4
University of Ottawa, Ottawa, Ontario, Canada.
5
Jewish General Hospital and McGill University, Montreal, Quebec, Canada.
6
Istanbul University, Istanbul, Turkey.
7
University of Connecticut Health Center, Farmington.
8
University of Queensland, Brisbane, Queensland, Australia.
9
North Shore LIJ Health System, Great Neck, New York.
10
Centre Hospitalier and School of Medicine of the University of Montreal, Montreal, Quebec, Canada.
11
University of Toronto and University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada.
12
Hospital General de México and Universidad Nacional Autónoma de México, Mexico City, Mexico.
13
Northwestern University Feinberg School of Medicine, Chicago, Illinois.
14
University of Western Ontario, London, Ontario, Canada.

Abstract

OBJECTIVE:

To establish agreement on systemic lupus erythematosus (SLE) treatment.

METHODS:

SLE experts (n = 69) were e-mailed scenarios and indicated preferred treatments. Algorithms were constructed and agreement determined (≥50% respondents indicating ≥70% agreement).

RESULTS:

Initially, 54% (n = 37) responded suggesting treatment for scenarios; 13 experts rated agreement with scenarios. Fourteen of 16 scenarios had agreement as follows: discoid lupus: first-line therapy was topical agents and hydroxychloroquine and/or glucocorticoids then azathioprine and subsequently mycophenolate (mofetil); uncomplicated cutaneous vasculitis: initial treatment was glucocorticoids ± hydroxychloroquine ± methotrexate, followed by azathioprine or mycophenolate and then cyclophosphamide; arthritis: initial therapy was hydroxychloroquine and/or glucocorticoids, then methotrexate and subsequently rituximab; pericarditis: first-line therapy was nonsteroidal antiinflammatory drugs, then glucocorticoids with/without hydroxychloroquine, then azathioprine, mycophenolate, or methotrexate and finally belimumab or rituximab, and/or a pericardial window; interstitial lung disease/alveolitis: induction was glucocorticoids and mycophenolate or cyclophosphamide, then rituximab or intravenous gamma globulin (IVIG), and maintenance followed with azathioprine or mycophenolate; pulmonary hypertension: glucocorticoids and mycophenolate or cyclophosphamide and an endothelin receptor antagonist were initial therapies, subsequent treatments were phosphodiesterase-5 inhibitors and then prostanoids and rituximab; antiphospholipid antibody syndrome: standard anticoagulation with/without hydroxychloroquine, then a thrombin inhibitor for venous thrombosis, versus adding aspirin or platelet inhibition drugs for arterial events; mononeuritis multiplex and central nervous system vasculitis: first-line therapy was glucocorticoids and cyclophosphamide followed by maintenance with azathioprine or mycophenolate, and then rituximab, IVIG, or plasmapheresis; and serious lupus nephritis: first-line therapy was glucocorticoids and mycophenolate, then cyclophosphamide then rituximab.

CONCLUSION:

We established variable agreement on treatment approaches. For some treatment decisions there was good agreement between experts even if no randomized controlled trial data were available.

PMID:
25777803
DOI:
10.1002/acr.22589
[Indexed for MEDLINE]
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